Provider Demographics
NPI:1386967743
Name:FLEWELLING, ROBERT J (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:FLEWELLING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 HOLMUR DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3621
Mailing Address - Country:US
Mailing Address - Phone:248-980-7997
Mailing Address - Fax:248-698-8993
Practice Address - Street 1:2011 CROOKS RD
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-4049
Practice Address - Country:US
Practice Address - Phone:248-980-7997
Practice Address - Fax:248-698-8993
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical