MEDICARE: DR. MATTHEW WILLIAM BROSI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	4101006350	MI

General Provider Information

NPI Number	:	1245447572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW WILLIAM BROSI PH.D.

Provider Business Mailing Address
First Line	:	6719 S WESTERN RD
Second Line	:
City	:	STILLWATER
State	:	OK
Zip	:	74074-2413
Country	:	US
Telephone Number	:	405-707-8069
Fax Number	:

Provider Business Practice Location Address
First Line	:	CENTER FOR FAMILY SERVICES
Second Line	:	101 HUMAN ENVIRONMENTAL SCIENCES WEST
City	:	STILLWATER
State	:	OK
Zip	:	74078-6122
Country	:	US
Telephone Number	:	405-744-5058
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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