Provider Demographics
NPI:1659410181
Name:BELLER, JAMES PATRICK (MA LMHC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:PATRICK
Last Name:BELLER
Suffix:
Gender:M
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 DELTONA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8016
Mailing Address - Country:US
Mailing Address - Phone:386-259-5413
Mailing Address - Fax:
Practice Address - Street 1:711 BALLARD ST
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5441
Practice Address - Country:US
Practice Address - Phone:407-758-0245
Practice Address - Fax:407-862-2737
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6626101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763550800Medicaid