Provider Demographics
NPI:1932324464
Name:BERNARD, JEFFREY E
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
Last Name:BERNARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320814
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-0014
Mailing Address - Country:US
Mailing Address - Phone:810-424-6202
Mailing Address - Fax:810-424-6204
Practice Address - Street 1:314 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2522
Practice Address - Country:US
Practice Address - Phone:810-424-6202
Practice Address - Fax:810-424-6204
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006666101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health