| Doctor Name: | MR. JOHN R DEBRUYNE |
| NPI Number: | 1326138595 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S.W., M.B.A |
| License Number: | I-0004362 |
| Business Practice Address: | 6833 Sylvania Petersburg Rd Ottawa Lake, MI - 492679523 |
| Business Phone Number: | 7348546207 |
| Business Fax Number: | 4198241558 |
| Mailing Address: | 6833 Sylvania Petersburg Rd, OTTAWA LAKE |
| State: | MI |
| Postal Code: | 492679523 |
| Phone Number: | 7348546207 |
| Fax Number: | 4198241558 |
| NPI Enumeration Date: | 10/16/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-0004362 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |