Provider Demographics
NPI:1578875902
Name:FLEVARIS, ANTHONY D JR (MR)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:D
Last Name:FLEVARIS
Suffix:JR
Gender:M
Credentials:MR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 WILLIAMSTON CT
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-5146
Mailing Address - Country:US
Mailing Address - Phone:248-736-5966
Mailing Address - Fax:
Practice Address - Street 1:31583 ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1121
Practice Address - Country:US
Practice Address - Phone:248-736-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1105910101YM0800X
MI6401011789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health