Provider Demographics
NPI:1083760326
Name:BELLINGHAM, JOHN ALEXANDER JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:BELLINGHAM
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8358 S LOOMIS RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9752
Mailing Address - Country:US
Mailing Address - Phone:517-669-8008
Mailing Address - Fax:
Practice Address - Street 1:1801 E SAGINAW ST
Practice Address - Street 2:SUITE H
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2326
Practice Address - Country:US
Practice Address - Phone:517-482-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005594103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI038598OtherVALUE OPTIONS
MI68-O-C3-4623-OOtherBCBSM
MI038598OtherVALUE OPTIONS