Provider Demographics
NPI:1285034801
Name:BELLAMY, MOSES EDWARD
Entity Type:Individual
Prefix:MR
First Name:MOSES
Middle Name:EDWARD
Last Name:BELLAMY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MOSES
Other - Middle Name:
Other - Last Name:BELLAMY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA LICDC-CS
Mailing Address - Street 1:770 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1419
Mailing Address - Country:US
Mailing Address - Phone:614-359-7066
Mailing Address - Fax:
Practice Address - Street 1:770 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43222-1419
Practice Address - Country:US
Practice Address - Phone:614-359-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001345101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)