Provider Demographics
NPI:1073501110
Name:BRUNING, ELIZABETH GARBER (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GARBER
Last Name:BRUNING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10850 E TRAVERSE HWY
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-1364
Mailing Address - Country:US
Mailing Address - Phone:231-935-0790
Mailing Address - Fax:231-935-0791
Practice Address - Street 1:10850 E TRAVERSE HWY
Practice Address - Street 2:SUITE 4000
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-1364
Practice Address - Country:US
Practice Address - Phone:231-935-0790
Practice Address - Fax:231-935-0791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008608103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM21750Medicare ID - Type Unspecified