Provider Demographics
NPI:1902129943
Name:BELLAMY, ALLEN REGINALD (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:REGINALD
Last Name:BELLAMY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N SAGINAW ST STE 201
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48502-2045
Mailing Address - Country:US
Mailing Address - Phone:810-584-0404
Mailing Address - Fax:810-496-3780
Practice Address - Street 1:400 N SAGINAW ST STE 201
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48502-2045
Practice Address - Country:US
Practice Address - Phone:810-584-0404
Practice Address - Fax:810-496-3780
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013459103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical