Hackworth, Bruce Patrick

Hackworth, Bruce Patrick is an individual health care provider with primary practice located at 811 Ship St Suite 4B, Saint Joseph MI 49085-1171. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Hackworth, Bruce Patrick can be contacted via phone (269) 985-3618.

Contact Information

Primary practice address
811 Ship St Suite 4B Saint Joseph MI 49085-1171
Phone: (269) 985-3618
Fax: (269) 609-6009
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 6801018724 Michigan

Profile Details

NPI number 1063448918
LBN Legal business name Hackworth, Bruce Patrick
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2006
Last updated Jan 1st, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063448918 NPPES
Michigan MEDICAID 1716175
Michigan Other 1699155226

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