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General NPI Number Information
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NPI Number | 1538658083
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Entity Type | Individual
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Provider Name | BROOK BERNREUTER
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Gender | Female
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 18303 E 10 MILE RD STE 200
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City | ROSEVILLE
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State | MI
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Zip | 48066-4989
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Country | US
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Telephone | 800-693-1916
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Fax |
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Provider Business Mailing Address
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Address Line | 8428 ESSEX AVE
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City | WARREN
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State | MI
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Zip | 48089-1766
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Country | US
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Telephone | 989-415-6714
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6361007706
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License Number State | MI
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