=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487667846
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN BROWN VORE PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3095 S DYE RD SUITE A
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-732-6030
-----------------------------------------------------
Fax | 810-732-0551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3095 S DYE RD SUITE A
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48507-1001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-732-6030
-----------------------------------------------------
Fax | 810-732-0551
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 001720
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------