Provider Demographics
NPI:1093940256
Name:WITHEROW, BELINDA C (MS)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:C
Last Name:WITHEROW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3115
Mailing Address - Country:US
Mailing Address - Phone:219-362-5000
Mailing Address - Fax:219-362-5005
Practice Address - Street 1:1501 STATE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3115
Practice Address - Country:US
Practice Address - Phone:219-362-5000
Practice Address - Fax:219-362-5005
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health