| Bruce G Douglass Phd Pc | |
|
5088 Village Lane Ct Traverse City MI 49685-6924 | |
| (231) 342-5877 | |
| (231) 943-2108 |
| Full Name | Bruce G Douglass Phd Pc |
|---|---|
| Speciality | Psychologist - Family |
| Location | 5088 Village Lane Ct, Traverse City, Michigan |
| Authorized Official Name and Position | Bruce G Douglass (MANAGER) |
| Authorized Official Contact | 2313425877 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bruce G Douglass Phd Pc 5088 Village Lane Ct Traverse City MI 49685-6924 Ph: (231) 342-5877 | Bruce G Douglass Phd Pc 5088 Village Lane Ct Traverse City MI 49685-6924 Ph: (231) 342-5877 |
| NPI Number | 1659513208 |
|---|---|
| Provider Enumeration Date | 03/28/2009 |
| Last Update Date | 02/27/2021 |
| Certification Date | 02/27/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659513208 | NPI | - | NPPES |
| 680B84509 | Other | MI | BCBSM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TF0000X | Psychologist - Family | 6301003193 (Michigan) | Primary |
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