Provider Demographics
NPI:1497963102
Name:BELOSO, JEAN SANDERS (MA)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:SANDERS
Last Name:BELOSO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 MELARKEY ST STE 210
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-3168
Mailing Address - Country:US
Mailing Address - Phone:775-623-2263
Mailing Address - Fax:
Practice Address - Street 1:530 MELARKEY ST STE 210
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3168
Practice Address - Country:US
Practice Address - Phone:775-623-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NV01056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist