Healthcare Provider Details

I. General information

NPI: 1336086768
Provider Name (Legal Business Name): JACOB MICHAEL BELLAMY LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MAIN ST STE C
MILFORD MI
48381-1975
US

IV. Provider business mailing address

2790 PATRICK HENRY ST APT 703
AUBURN HILLS MI
48326-2262
US

V. Phone/Fax

Practice location:
  • Phone: 248-529-6383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: