Basic Information
| Provider Information | |||||||||
| NPI: | 1144669318 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELLAMY | ||||||||
| FirstName: | JULIA | ||||||||
| MiddleName: | HELENE | ||||||||
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| Credential: | PHD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DELEKTA | ||||||||
| OtherFirstName: | JULIE | ||||||||
| OtherMiddleName: | HELENE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | PHD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1560 E MAPLE RD | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480831135 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3901 CHRYSLER DR STE 3B | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135771396 | ||||||||
| FaxNumber: | 3135778823 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2013 | ||||||||
| LastUpdateDate: | 12/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 6301014874 | MI | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.