Provider Demographics
NPI:1114341294
Name:BELJAN, KRISTYN NICOLE
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:NICOLE
Last Name:BELJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTYN
Other - Middle Name:NICOLE
Other - Last Name:YEATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3614 MADISON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 VIKING WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1138
Practice Address - Country:US
Practice Address - Phone:513-864-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3151534103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool