1740816362 NPI number — DR. TIFFANY MICHELE BELLAMY PSYD

Table of content: DR. TIFFANY MICHELE BELLAMY PSYD (NPI 1740816362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740816362 NPI number — DR. TIFFANY MICHELE BELLAMY PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELLAMY
Provider First Name:
TIFFANY
Provider Middle Name:
MICHELE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740816362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
510 BONNIE BRAE PL APT L1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER FOREST
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60305-1946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-205-7369
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 MIDWEST RD STE 100C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-1394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-224-8305
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  178.009052 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com