| NPI | 1699155226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE PATRICK HACKWORTH Owner/Licensed Psychologist 269-985-3618 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MI 6301006344) |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2015-06-09 |