Organization
BRUCE G DOUGLASS PHD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE G DOUGLASS PHD (MANAGER)
(231) 342-5877
Entity
Organization
Contact information
Practice address
5088 VILLAGE LANE CT, TRAVERSE CITY, MI 49685-6924
(231) 342-5877
(231) 943-2108
Mailing address
5088 VILLAGE LANE CT, TRAVERSE CITY, MI 49685-6924
(231) 342-5877
(231) 943-2108
Taxonomy
Speciality
Code
Description
License number
State
103TF0000X
Family Psychologist
Primary
6301003193
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680B84509
BCBSM
MI
Enumeration date
03/28/2009
Last updated
02/27/2021
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