Doctor Name: | MERLENE GAY BRUSH |
NPI Number: | 1114065687 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A. L.P.C. |
License Number: | 002255 |
Business Practice Address: | 5239 Blue Ridge Blvd Raytown, MO - 641333060 |
Business Phone Number: | 8163561354 |
Business Fax Number: | |
Mailing Address: | 5239 Blue Ridge Blvd, RAYTOWN |
State: | MO |
Postal Code: | 641333060 |
Phone Number: | 8163561354 |
Fax Number: | |
NPI Enumeration Date: | 02/04/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 002255 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |