Active NPI
Ellen Mayfield-Fleming, MALLP
- Clinical Psychologist
- Clinton TWP, MI
National Provider Identifier
1104071927
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301010626
- Practice address
- 42669 Garfield Rd
Clinton TWP, MI 48038-5036 - Phone
- (586) 412-5321
- NPI assigned
- Nov 20, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 6301010626 | MI | Primary |
Addresses
Primary practice location
42669 Garfield Rd
Clinton TWP, MI 48038-5036
Mailing address
12850 Fountain SQ
Davisburg, MI 48350-2552
Phone (248) 634-6303
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 750910642 | Other | MI | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301010626 | MI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227139200000",
"number": "1104071927",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12850 FOUNTAIN SQ",
"city": "DAVISBURG",
"state": "MI",
"postal_code": "483502552",
"telephone_number": "248-634-6303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42669 GARFIELD RD",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480385036",
"telephone_number": "586-412-5321"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYFIELD-FLEMING",
"first_name": "ELLEN",
"credential": "MALLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-11-20",
"last_updated": "2008-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301010626",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "750910642",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clinton TWP, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.