NPIMap

Organization Active NPI

J Flack PSYD PC

Doing business as Fenton Wellness

  • Psychologist
  • Fenton, MI
National Provider Identifier
1770859001
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301014240 Issued in MI
Legal business name
J FLACK PSYD PC
Doing business as
Fenton Wellness
Practice address
127 N River St
Fenton, MI 48430-3800
Phone
(810) 309-9355
NPI assigned
Mar 30, 2012
Last updated
Jan 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Authorized official

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

Specialties & licenses 3

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

  • Fenton Wellness Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120725000401 MI Part B Supplier - Clinic/Group Practice 0547426264 Receives reassigned benefits from 11 practitioners
Practice locations: Fenton, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1333065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737504000000",
    "number": "1770859001",
    "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": "J FLACK PSYD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-30",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A",
        "authorized_official_last_name": "FLACK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-309-9355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D., LP"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MI",
            "license": "6401006094",
            "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fenton Wellness",
            "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 Jan 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.