MEDICARE: KATHERINE MARIE BRULEY M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301015333	MI

General Provider Information

NPI Number	:	1528406782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MARIE BRULEY M.A.

Provider Business Mailing Address
First Line	:	5448 KINGSFIELD DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-1488
Country	:	US
Telephone Number	:	313-671-3411
Fax Number	:

Provider Business Practice Location Address
First Line	:	5448 KINGSFIELD DR
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-1488
Country	:	US
Telephone Number	:	313-671-3411
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2013
Last Update Date	:	06/10/2013

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