Organization
ELIZABETH G BRUNING PHD PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH G BRUNING PHD (PSYCHOLOGIST)
(231) 935-0790
Entity
Organization
Contact information
Practice address
818 RED DR, SUITE 260, TRAVERSE CITY, MI 49684-4720
(231) 935-0790
(231) 935-0791
Mailing address
818 RED DRIVE, SUITE 260, TRAVERSE CITY, MI 49684
(231) 935-0790
(231) 935-0791
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301008608
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OM21750
MEDICARE PTAN
MI
Enumeration date
10/31/2011
Last updated
10/31/2011
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