Provider Demographics
NPI:1326138595
Name:DEBRUYNE, JOHN R II (MSW, MBA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:DEBRUYNE
Suffix:II
Gender:M
Credentials:MSW, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6833 SYLVANIA PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-9523
Mailing Address - Country:US
Mailing Address - Phone:734-854-6207
Mailing Address - Fax:419-824-1558
Practice Address - Street 1:6833 SYLVANIA PETERSBURG RD
Practice Address - Street 2:
Practice Address - City:OTTAWA LAKE
Practice Address - State:MI
Practice Address - Zip Code:49267-9523
Practice Address - Country:US
Practice Address - Phone:734-854-6207
Practice Address - Fax:419-824-1558
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00043621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical