DR. TERRY LEE RUDOLPH PH.D
NPI 1154320489
Psychologist - Clinical in Roseville, MI

Q: What is Terry Rudolph's NPI number?

The NPI number for Terry Rudolph is 1154320489. It was assigned to this individual provider in the NPPES registry on July 19, 2005.

Q: What is Terry Rudolph's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Terry Rudolph was last updated on March 8, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since July 19, 2005

25779 KELLY ROAD, ROSEVILLE, MI 48066(586) 774-7987(586) 774-7263 Get Directions Write a Review

NPPES record last updated: March 8, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Terry Lee Rudolph Ph.d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. TERRY LEE RUDOLPH PH.D (NPI 1154320489) is an individual clinical provider in Roseville, Michigan, licensed in Michigan (003357) and active in the NPI registry since July 2005.

NPPES Registry Identity

NPI1154320489

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameDR. TERRY LEE RUDOLPHCredential: PH.D

Location Address25779 KELLY ROADRoseville, MI 48066-4973

Mailing Address25779 Kelly RoadRoseville, MI 48066-4973 · (586) 774-7987 · Fax (586) 774-7263

Phone(586) 774-7987

Fax(586) 774-7263

Sole ProprietorNo

Enumeration DateJuly 19, 2005

Last NPPES UpdateMarch 8, 2011

✔ NPI 1154320489 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in MI · 003357

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedPsychologistTaxonomy 103T00000X · License 6301003357 (MI)

25779 KELLY ROAD, Roseville, MI 48066

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Other Identifiers 4

Other68-0-E0-4564-0MI · Blue Cross/blue Shield

Medicare UPIN0M-3837O0

Medicare UPIN79915

Medicare ID-Type Unspecified0M-38370

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Terry Rudolph's NPI number?

The NPI number for Terry Rudolph is 1154320489. It was assigned to this individual provider in the NPPES registry on July 19, 2005.

Where is Terry Rudolph located?

Terry Rudolph practices at 25779 Kelly Road, Roseville, MI 48066. The listed phone number is (586) 774-7987.

What is Terry Rudolph's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

When was this NPI record last updated?

The NPPES record for Terry Rudolph was last updated on March 8, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.