Provider Demographics
NPI:1740816362
Name:BELLAMY, TIFFANY MICHELE (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MICHELE
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BONNIE BRAE PL APT L1
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1946
Mailing Address - Country:US
Mailing Address - Phone:708-205-7369
Mailing Address - Fax:
Practice Address - Street 1:2021 MIDWEST RD STE 100C
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1394
Practice Address - Country:US
Practice Address - Phone:708-224-8305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-15
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009052101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health