Healthcare Provider Details

I. General information

NPI: 1891472239
Provider Name (Legal Business Name): DAVID MATTHEW BRUSH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 COOLIDGE HWY STE 101
TROY MI
48084-3215
US

IV. Provider business mailing address

2855 COOLIDGE HWY STE 101
TROY MI
48084-3215
US

V. Phone/Fax

Practice location:
  • Phone: 248-270-5974
  • Fax:
Mailing address:
  • Phone: 248-270-5974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301019257
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019257
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: