Active NPI
Jennifer Flack Thelen, PSY.D., LP
- Clinical Psychologist
- Fenton, MI
National Provider Identifier
1821221631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301013884
- Practice address
- 127 N River St
Fenton, MI 48430-3800 - Phone
- (810) 309-9355
- NPI assigned
- Aug 26, 2009
- Last updated
- May 15, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 | 6301013884 | MI | Primary |
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
- Dr. Jennifer Lenore Flack
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
127 N River St
Fenton, MI 48430-3800
Phone (810) 309-9355
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301013884 | MI | MD | Clinical Psychologist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747267200000",
"number": "1821221631",
"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": {
"last_name": "THELEN",
"first_name": "JENNIFER",
"middle_name": "FLACK",
"name_prefix": "Dr.",
"credential": "PSY.D., LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-08-26",
"last_updated": "2025-05-15",
"certification_date": "2025-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301013884",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "FLACK",
"middle_name": "LENORE",
"prefix": "DR.",
"credential": "PSYD, LP",
"code": "1",
"type": "Former Name"
}
]
}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 May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.