Provider Demographics
NPI:1114174349
Name:BELTZ, CASSIE D (EDS, LPC)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:D
Last Name:BELTZ
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:D
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, PLPC
Mailing Address - Street 1:409 KENYON RD STE C
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5718
Mailing Address - Country:US
Mailing Address - Phone:515-573-3138
Mailing Address - Fax:
Practice Address - Street 1:2370 MERINO AVE
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-9107
Practice Address - Country:US
Practice Address - Phone:870-476-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008024213101YP2500X
IA001503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional