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General NPI Number Information
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NPI Number | 1093412603
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Entity Type | Individual
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Provider Name | BRIAN EMIL BOSSICK PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2023
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 1 CAMPUS DR
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City | ALLENDALE
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State | MI
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Zip | 49401-9401
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Country | US
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Telephone | 616-331-3266
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Fax |
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Provider Business Mailing Address
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Address Line | 5643 TRINITY LN SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-8868
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Country | US
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Telephone | 616-450-7793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301014916
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License Number State | MI
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