Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301008608 | MI |
NPI | 1073501110 |
---|---|
Provider Name | Dr. Elizabeth Garber Bruning |
First Address | Traverse City, MI 49684-1364 |
Second Address | Traverse City, MI 49684-1364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |