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General NPI Number Information
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NPI Number | 1669511325
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Entity Type | Organization
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Legal Business Name | DAVID J FUGATE PHD PLLC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1660 HASLETT RD SUITE 1
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City | HASLETT
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State | MI
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Zip | 48840-8469
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Country | US
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Telephone | 517-347-8420
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Fax |
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Provider Business Mailing Address
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Address Line | 1660 HASLETT RD SUITE 1
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City | HASLETT
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State | MI
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Zip | 48840-8469
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Country | US
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Telephone | 517-347-8420
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST OWNER
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Name | DR. DAVID JAMES FUGATE
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Credential | PHD
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Telephone | 517-347-8420
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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 | 6301006608
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License Number State | MI
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