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General NPI Number Information
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NPI Number | 1174809511
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Entity Type | Organization
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Legal Business Name | ELIZABETH G BRUNING PHD PLLC
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Dates
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Enumeration Date | 10/31/2011
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 818 RED DR SUITE 260
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-4720
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Country | US
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Telephone | 231-935-0790
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Fax | 231-935-0791
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Provider Business Mailing Address
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Address Line | 818 RED DRIVE SUITE 260
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City | TRAVERSE CITY
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State | MI
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Zip | 49684
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Country | US
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Telephone | 231-935-0790
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Fax | 231-935-0791
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | ELIZABETH G BRUNING
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Credential | PHD
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Telephone | 231-935-0790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301008608
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License Number State | MI
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