Healthcare Provider Details

I. General information

NPI: 1629860069
Provider Name (Legal Business Name): JEFF CHMIELEWSKI LLPC, ATR-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29887 W 11 MILE RD
FARMINGTON HILLS MI
48336-1309
US

IV. Provider business mailing address

5468 LAWNWOOD DR
BRIGHTON MI
48114-9085
US

V. Phone/Fax

Practice location:
  • Phone: 248-476-8860
  • Fax:
Mailing address:
  • Phone: 810-599-1891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number24-685
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023934
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: