Provider Demographics
NPI:1477663581
Name:BELT, JACQUELYN R (PH D)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:R
Last Name:BELT
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9221 WARD PARKWAY
Mailing Address - Street 2:STE 430
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114
Mailing Address - Country:US
Mailing Address - Phone:816-444-5511
Mailing Address - Fax:816-822-8058
Practice Address - Street 1:9221 WARD PARKWAY
Practice Address - Street 2:STE 430
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114
Practice Address - Country:US
Practice Address - Phone:816-444-5511
Practice Address - Fax:816-822-8058
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMOPY01575103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist