Provider Demographics
NPI:1043721558
Name:LICEA, BELINDA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:LICEA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17951 GEORGIA RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-4957
Mailing Address - Country:US
Mailing Address - Phone:417-322-2529
Mailing Address - Fax:
Practice Address - Street 1:1228 DEADRA DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-4669
Practice Address - Country:US
Practice Address - Phone:417-991-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO21619189101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health