Dr Bruce a Fowler P C

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301006137 Issued in MI

Legal business name

DR BRUCE A FOWLER P C

Practice address

2090 Celebration Dr NE
Suite 212
Grand Rapids, MI 49525-9200

Phone

(616) 450-4601

Fax

(616) 608-0108

NPI assigned

Jul 6, 2007

Organization subpart

No

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

• Bruce Allen Fowler, PSY.D.

  • Clinical Psychologist
  • Grand Rapids, MI
  • NPI 1881792497

  MI

  Medicare reassignment Authorized official

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

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

Authorized official

Name

Dr. Bruce Allen Fowler, PSY.D.NPI 1881792497

Title

President

Phone

(616) 450-4601

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 16, 2024.

{
    "created_epoch": "1183680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715817600000",
    "number": "1992903363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 CELEBRATION DR NE",
            "address_2": "SUITE 212",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259200",
            "telephone_number": "616-450-4601",
            "fax_number": "616-608-0108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 CELEBRATION DR NE",
            "address_2": "SUITE 212",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259200",
            "telephone_number": "616-450-4601",
            "fax_number": "616-608-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR BRUCE A FOWLER P C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-06",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A",
        "authorized_official_last_name": "FOWLER",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-450-4601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301006137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Thomas Doyle, DO
• Carmen G Dozeman, M.D.
• Michael Dozeman, M.D.
• Michele Dozeman
• Rebecca Dozeman, LLMSW
• Dr Daniel Roberts PLLC
• Dr Eric J Foster DDS PLC
• Dr Fred PLLC
• Dr Marcia Hollingsworth, Ed.D, PLLC
• Dr Marianne K Moayer OD PLLC

• All providers in Grand Rapids, MI
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.