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General NPI Number Information
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NPI Number | 1467721787
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Entity Type | Organization
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Legal Business Name | OPEN DOOR PSYCHOLOGY, L.L.C.
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 3534 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30005-4459
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Country | US
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Telephone | 404-735-8353
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Fax |
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Provider Business Mailing Address
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Address Line | 3534 OLD MILTON PKWY
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City | ALPHARETTA
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State | GA
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Zip | 30005-4459
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Country | US
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Telephone | 404-735-8353
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/MANAGER
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Name | WILLIAM E BRUER
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Credential | PSY.D.
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Telephone | 404-735-8353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY003499
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License Number State | GA
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