Provider Demographics
NPI:1093103822
Name:BELASCHKY, KIMBERLY (MED, LPC, BCBA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BELASCHKY
Suffix:
Gender:F
Credentials:MED, LPC, BCBA
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:FRIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC, BCBA
Mailing Address - Street 1:23904 CROOKED CRK
Mailing Address - Street 2:
Mailing Address - City:HOCKLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77447-7541
Mailing Address - Country:US
Mailing Address - Phone:281-905-8179
Mailing Address - Fax:
Practice Address - Street 1:301 WELLS FARGO DR
Practice Address - Street 2:SUITE 12
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-4060
Practice Address - Country:US
Practice Address - Phone:317-334-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-01
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-17637103K00000X
TX70257101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional