Organization
FENTON WELLNESS
Active
Other names
Jennifer Flack
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER LENORE FLACK PSY.D. (OWNER)
(810) 309-9355
Entity
Organization
Contact information
Practice address
127 N RIVER ST, FENTON, MI 48430-3800
(810) 309-9355
Mailing address
127 N RIVER ST, FENTON, MI 48430-3800
(810) 309-9355
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
6401006094
MI
103T00000X
Psychologist
6301002268
MI
103T00000X
Psychologist
6301005725
MI
103T00000X
Psychologist
Primary
6301014240
MI
104100000X
Social Worker
6801006671
MI
104100000X
Social Worker
6801019131
MI
Other
Enumeration date
06/03/2010
Last updated
07/19/2011
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