Provider Demographics
NPI:1073944302
Name:BELOIT PSYCHOTHERAPY
Entity Type:Organization
Organization Name:BELOIT PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KARI BELL
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:608-290-2286
Mailing Address - Street 1:3005 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511
Mailing Address - Country:US
Mailing Address - Phone:608-346-8315
Mailing Address - Fax:
Practice Address - Street 1:3005 RIVERSIDE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-1500
Practice Address - Country:US
Practice Address - Phone:608-346-8315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15601-132101YA0400X
WI1091-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty