Provider Demographics
NPI:1376523514
Name:AMBROSE, BELINDA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:JANE
Last Name:AMBROSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-4246
Mailing Address - Country:US
Mailing Address - Phone:713-802-0545
Mailing Address - Fax:
Practice Address - Street 1:520 W 14TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-4114
Practice Address - Country:US
Practice Address - Phone:713-802-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4940103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L81NMedicare ID - Type Unspecified