Terry Lee Rudolph in Roseville - Psychologist
Terry Lee Rudolph - NPI 1154320489
Terry Lee Rudolph is a Psychologist in Roseville, Michigan. Terry Lee Rudolph practices all healthcare services and medical treatments related to Psychologist. The NPI Number for Terry Lee Rudolph is 1154320489. The last update date is 2011-03-08.
Terry Lee Rudolph's current location address is 25779 Kelly Road, Roseville, Michigan. You can contact this provider via phone number 5867747987 and fax number 5867747263. The mailing address for Terry Lee Rudolph is 25779 Kelly Road, Roseville, Michigan. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Terry Lee Rudolph |
|---|---|
| Address | 25779 Kelly Road, Roseville, Michigan |
| Phone Number | 5867747987 |
| Fax Number | 5867747263 |
| Sole Proprietor | N |
| Credentials | PH.D |
NPI Number Detail
| NPI Number | 1154320489 |
|---|---|
| Provider Enumeration Date | 2005-07-19 |
| Last Updated Date | 2011-03-08 |
Provider Mailing Address Detail
| Address | 25779 Kelly Road |
|---|---|
| City | Roseville |
| State | Michigan (MI) |
| Post Code | 480664973 |
| Phone Number | 5867747987 |
| Fax Number | 5867747263 |
Provider's Primary Taxonomy Detail
| Speciality | Psychologist |
|---|---|
| Taxonomy | 103T00000X |
| Licence No | 6301003357 |
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Definition: A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and proce |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 68-0-E0-4564-0 | MI | BLUE CROSS/BLUE SHIELD |
Post Comment/ Review Below
What is the unique 10-digit identification code issued to Terry Lee Rudolph by the Centers for Medicare & Medicaid Services?
The Terry Lee Rudolph has been assigned the NPI (National Provider Identifier) 1154320489 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for healthcare providers.
Could you please provide the complete physical location address of Terry Lee Rudolph?
The Terry Lee Rudolph is physically situated at 25779 Kelly Road, in the city of Roseville, state of MI, with the postal code 480664973.
What is Terry Lee Rudolph's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Terry Lee Rudolph's specialized field of practice is Psychologist, and the corresponding taxonomy code that categorizes this area of specialization is 103T00000X.
On what date did the Terry Lee Rudolph receive its 1154320489 assignment from the Centers for Medicare & Medicaid Services?
The Terry Lee Rudolph was assigned its 1154320489 by the Centers for Medicare & Medicaid Services on 2005-07-19.
When was the information pertaining to Terry Lee Rudolph most recently updated or revised?
The details related to Terry Lee Rudolph, including its address, specialty, and other relevant information, were last updated or revised on 2011-03-08.
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