Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6301005594 | MI |
NPI | 1083760326 |
---|---|
Provider Name | Dr. John Alexander Bellingham JR. |
First Address | Dewitt, MI 48820-9752 |
Second Address | Lansing, MI 48912-2326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
038598 | VALUE OPTIONS (01) | MI |
68-O-C3-4623-O | BCBSM (01) | MI |