Healthcare Provider Details

I. General information

NPI: 1700946027
Provider Name (Legal Business Name): BRUCE WILFRED MCGHEE LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 PROSPECT AVE
CARO MI
48723-9288
US

IV. Provider business mailing address

323 N STATE ST PO BOX 239
CARO MI
48723-1537
US

V. Phone/Fax

Practice location:
  • Phone: 989-673-6191
  • Fax: 989-672-3443
Mailing address:
  • Phone: 989-673-6191
  • Fax: 989-672-2199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801089549
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: