Provider Demographics
NPI:1861512329
Name:J. BRUCE HILLENBERG, PH.D., P.L.L.C.
Entity Type:Organization
Organization Name:J. BRUCE HILLENBERG, PH.D., P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:HILLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-892-4364
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty