NPIMap

Organization Active NPI

Elizabeth G Bruning PHD PLLC

  • Psychologist
  • Traverse City, MI
National Provider Identifier
1174809511
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301008608 Issued in MI
Legal business name
ELIZABETH G BRUNING PHD PLLC
Practice address
818 Red Dr
Suite 260
Traverse City, MI 49684-4720
Phone
(231) 935-0790
Fax
(231) 935-0791
NPI assigned
Oct 31, 2011
Last updated
Oct 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elizabeth G Bruning, PHDNPI 1073501110
Title
Psychologist
Phone
(231) 935-0790

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301008608 MI Primary

Addresses

Primary practice location

818 Red Dr
Suite 260
Traverse City, MI 49684-4720

Mailing address

818 Red Drive
Suite 260
Traverse City, MI 49684
Phone (231) 935-0790

Other identifiers 1

IdentifierTypeStateIssuer
OM21750OtherMIMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

818 Red Dr
Ste 260
Traverse City, MI 49684
Phone (231) 935-0790

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1174809511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 RED DRIVE",
            "address_2": "SUITE 260",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-935-0790",
            "fax_number": "231-935-0791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 RED DR",
            "address_2": "SUITE 260",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844720",
            "telephone_number": "231-935-0790",
            "fax_number": "231-935-0791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZABETH G BRUNING PHD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "BRUNING",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "231-935-0790",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301008608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "OM21750",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.