Provider Demographics
NPI:1922561059
Name:BELLINGER, ODIS (LLPC)
Entity Type:Individual
Prefix:
First Name:ODIS
Middle Name:
Last Name:BELLINGER
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24901 NORTHWESTERN HWY STE 318
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2207
Mailing Address - Country:US
Mailing Address - Phone:313-772-0110
Mailing Address - Fax:
Practice Address - Street 1:24901 NORTHWESTERN HWY STE 318
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2207
Practice Address - Country:US
Practice Address - Phone:313-772-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451015053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty