| Doctor Name: | DR. RANDAL CLAY BRUCE |
| NPI Number: | 1306834551 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 6301007332 |
| Business Practice Address: | 1350 E West Maple Rd Walled Lake, MI - 483903727 |
| Business Phone Number: | 2486248181 |
| Business Fax Number: | |
| Mailing Address: | Po Box 3380, FARMINGTON HILLS |
| State: | MI |
| Postal Code: | 483333380 |
| Phone Number: | 2486248181 |
| Fax Number: | 8556248161 |
| NPI Enumeration Date: | 10/12/2005 |
| NPI Last Update Date: | 12/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TB0200X |
| License Number: | 6301007332 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Cognitive & Behavioral |
| Taxonomy Definition: | |