Provider Demographics
NPI:1467899559
Name:BELFORD, MICHELLE RENE (LPC)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:RENE
Last Name:BELFORD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W MAIN ST
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:GLENWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60425-1677
Mailing Address - Country:US
Mailing Address - Phone:708-758-6800
Mailing Address - Fax:708-758-6849
Practice Address - Street 1:23 W MAIN ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:GLENWOOD
Practice Address - State:IL
Practice Address - Zip Code:60425-1677
Practice Address - Country:US
Practice Address - Phone:708-758-6800
Practice Address - Fax:708-758-6849
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional