Individual
TERRY L BRACISZEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D,
Contact information
Practice address
7926 ANN ARBOR ST, DEXTER, MI 48130-1344
(734) 320-2497
(810) 231-0771
Mailing address
224 W SIBLEY ST, HOWELL, MI 48843-2221
(734) 320-2497
(810) 231-0771
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC0700X
Clinical Psychologist
Primary
6301006431
MI
103TH0100X
Health Service Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
6301006431
MI
103TR0400X
Rehabilitation Psychologist
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610093200
ACS/OWCP
OH
01
—
680H146930
BCBSM
MI
Enumeration date
08/12/2006
Last updated
08/26/2019
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