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General NPI Number Information
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NPI Number | 1891959706
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Entity Type | Individual
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Provider Name | TERRI IRENE WOOD BRUININKS LMSW
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Gender | Female
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 4200 W MICHIGAN AVE STE 60
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City | KALAMAZOO
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State | MI
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Zip | 49006-5895
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Country | US
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Telephone | 269-377-7863
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Fax |
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Provider Business Mailing Address
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Address Line | 5805 OAKLAND DR
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City | PORTAGE
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State | MI
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Zip | 49024-1118
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Country | US
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Telephone | 269-323-4180
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6801089579
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License Number State | MI
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