Provider Demographics
NPI:1033158324
Name:HILLENBERG, JEFFRY BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:BRUCE
Last Name:HILLENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32215 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-1638
Mailing Address - Country:US
Mailing Address - Phone:248-892-4364
Mailing Address - Fax:248-855-3983
Practice Address - Street 1:3577 W 13 MILE RD
Practice Address - Street 2:SUITE 142
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-892-4364
Practice Address - Fax:248-551-8437
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI71020000F34840OtherBLUE CROSS AND BLUE SHIEL
MI71020000F34840OtherBLUE CROSS AND BLUE SHIEL