Healthcare Provider Details

I. General information

NPI: 1467476846
Provider Name (Legal Business Name): BRUCE FORBES SEITZER M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 N CLARK ST
CHICAGO IL
60640-4689
US

IV. Provider business mailing address

1607 ELMWOOD AVE
WILMETTE IL
60091-1553
US

V. Phone/Fax

Practice location:
  • Phone: 773-765-0790
  • Fax:
Mailing address:
  • Phone: 847-256-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: