Provider Demographics
NPI:1083139604
Name:BRUTON, CHERI ANN (MS)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:ANN
Last Name:BRUTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27604 KINGSGATE WAY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3613
Mailing Address - Country:US
Mailing Address - Phone:248-747-0637
Mailing Address - Fax:
Practice Address - Street 1:26520 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48240-1506
Practice Address - Country:US
Practice Address - Phone:313-533-5652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6401016008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health