Provider Demographics
NPI:1053742379
Name:BRUSS, MELANIE ELIZABETH (MA, LPC)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:ELIZABETH
Last Name:BRUSS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7289 EDWARD
Mailing Address - Street 2:
Mailing Address - City:CENTER LINE
Mailing Address - State:MI
Mailing Address - Zip Code:48015-1008
Mailing Address - Country:US
Mailing Address - Phone:313-775-9802
Mailing Address - Fax:313-775-9802
Practice Address - Street 1:2888 E LONG LAKE RD STE 170
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-7011
Practice Address - Country:US
Practice Address - Phone:248-864-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional