Provider Demographics
NPI:1750643151
Name:ROAN-BELLE, CLARISSA RENEE
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:RENEE
Last Name:ROAN-BELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 SUNNY SLOPE TRACE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5815
Mailing Address - Country:US
Mailing Address - Phone:859-368-4410
Mailing Address - Fax:
Practice Address - Street 1:1500 LEESTOWN RD STE 326
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-2047
Practice Address - Country:US
Practice Address - Phone:859-368-4410
Practice Address - Fax:859-368-4410
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162670103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist