Individual
DR. BRUCE PATRICK HACKWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
811 SHIP ST, SUITE 4B, SAINT JOSEPH, MI 49085-1171
(269) 985-3618
(269) 609-6009
Mailing address
811 SHIP ST, SUITE 4B, SAINT JOSEPH, MI 49085-1171
(269) 985-3618
(269) 609-6009
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6801018724
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699155226
LIGHTHOUSE BEHAVIORAL HEALTH PLLC - GROUP NPI
MI
05
—
1716175
—
MI
Enumeration date
06/23/2006
Last updated
01/01/2016
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