MEDICARE: DR. BRIAN JOHN SEELY PSY.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	103TC0700X	Clinical Psychologist	6301008276	MI

General Provider Information

NPI Number	:	1508928482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN JOHN SEELY PSY.D.

Provider Business Mailing Address
First Line	:	7465 SUNFISH LAKE CT NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9074
Country	:	US
Telephone Number	:	616-874-2811
Fax Number	:	616-874-2811

Provider Business Practice Location Address
First Line	:	7465 SUNFISH LAKE CT NE
Second Line	:
City	:	ROCKFORD
State	:	MI
Zip	:	49341-9074
Country	:	US
Telephone Number	:	616-874-2811
Fax Number	:	616-874-2811

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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