NPIMap

Organization Active NPI

Fenton Wellness

Doing business as Jennifer Flack

  • Psychologist
  • Fenton, MI
National Provider Identifier
1386964278
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301014240 Issued in MI
Legal business name
FENTON WELLNESS
Doing business as
Jennifer Flack
Practice address
127 N River St
Fenton, MI 48430-3800
Phone
(810) 309-9355
NPI assigned
Jun 3, 2010
Last updated
Jul 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jennifer Lenore Flack, PSY.D.
Title
Owner
Phone
(810) 309-9355

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 6401006094 MI
Psychologist 103T00000X 6301005725 MI
Psychologist 103T00000X 6301002268 MI
Psychologist 103T00000X 6301014240 MI Primary
Social Worker 104100000X 6801006671 MI
Social Worker 104100000X 6801019131 MI

Addresses

Primary practice location

127 N River St
Fenton, MI 48430-3800

Mailing address

127 N River St
Fenton, MI 48430-3800
Phone (810) 309-9355

Other names 1

  • Jennifer Flack Doing business as

National Provider Directory

National Provider Directory

Locations

127 N River St
Fenton, MI 48430
Phone (810) 309-9355

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1386964278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 N RIVER ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303800",
            "telephone_number": "810-309-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 N RIVER ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484303800",
            "telephone_number": "810-309-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FENTON WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-03",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "FLACK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LENORE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "810-309-9355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401006094",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301005725",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301002268",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301014240",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801006671",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6801019131",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jennifer Flack",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.