Bruce G Douglass PHD PC

Primary specialty

Family PsychologistTaxonomy code 103TF0000X

License

6301003193 Issued in MI

Legal business name

BRUCE G DOUGLASS PHD PC

Practice address

5088 Village Lane CT
Traverse City, MI 49685-6924

Phone

(231) 342-5877

Fax

(231) 943-2108

NPI assigned

Mar 28, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Bruce G Douglass, PHD

Title

Manager

Phone

(231) 342-5877

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Katharine C Douglass, M.S.

  • Clinical Child & Adolescent Psychologist
  • Traverse City, MI
  • NPI 1275607111
  NPD (past)

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

{
    "created_epoch": "1238198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614384000000",
    "number": "1659513208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5088 VILLAGE LANE CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496856924",
            "telephone_number": "231-342-5877",
            "fax_number": "231-943-2108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5088 VILLAGE LANE CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496856924",
            "telephone_number": "231-342-5877",
            "fax_number": "231-943-2108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCE G DOUGLASS PHD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-28",
        "last_updated": "2021-02-27",
        "certification_date": "2021-02-27",
        "status": "A",
        "authorized_official_last_name": "DOUGLASS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "231-342-5877",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Family",
            "state": "MI",
            "license": "6301003193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "680B84509",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natalie S Brown, M.D., PHD
• Thomas A. Brown, D.D.S.
• Tracy Lynn Brown
• Ashley Browne
• Hope Broxterman, PHARMD
• Wallace John Bruder, M.D.
• Kersti Bruining, M.D.
• Bria L Brunette
• Elizabeth Garber Bruning, PH.D.
• John E Brunner, M.D.

• Family Psychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Family Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2021; 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.