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NPI Code Detail

MEDICARE: MR. BRUCE FORBES SEITZER M.A.

MEDICARE: MR. BRUCE FORBES SEITZER M.A.
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
1101YP2500XProfessional CounselorIL

General Provider Information

NPI Number : 1467476846
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRUCE FORBES SEITZER M.A.
Provider Business Mailing Address
First Line : 1607 ELMWOOD AVE
Second Line :
City : WILMETTE
State : IL
Zip : 60091-1553
Country : US
Telephone Number : 847-256-3760
Fax Number :
Provider Business Practice Location Address
First Line : 4740 N CLARK ST
Second Line :
City : CHICAGO
State : IL
Zip : 60640-4689
Country : US
Telephone Number : 773-765-0790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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