Provider Demographics
NPI:1700946027
Name:MCGHEE, BRUCE WILFRED (LMSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:WILFRED
Last Name:MCGHEE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 N STATE ST
Mailing Address - Street 2:PO BOX 239
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1537
Mailing Address - Country:US
Mailing Address - Phone:989-673-6191
Mailing Address - Fax:989-672-2199
Practice Address - Street 1:1332 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-9288
Practice Address - Country:US
Practice Address - Phone:989-673-6191
Practice Address - Fax:989-672-3443
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895491041C0700X
CALCS229561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0M29340Medicare PIN