Provider Demographics
NPI:1376212076
Name:BELISLE, TORI MARLENE (BS, MHP, RBT)
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:MARLENE
Last Name:BELISLE
Suffix:
Gender:F
Credentials:BS, MHP, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022-5721
Mailing Address - Country:US
Mailing Address - Phone:715-821-8114
Mailing Address - Fax:
Practice Address - Street 1:1160 CENTRE POINTE DR
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55120-1351
Practice Address - Country:US
Practice Address - Phone:952-401-9359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician