Provider Demographics
NPI:1821291071
Name:BELIVEAU, BOB D (MS,LP)
Entity Type:Individual
Prefix:
First Name:BOB
Middle Name:D
Last Name:BELIVEAU
Suffix:
Gender:M
Credentials:MS,LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1227
Mailing Address - Country:US
Mailing Address - Phone:218-259-9572
Mailing Address - Fax:
Practice Address - Street 1:409 4TH ST
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1227
Practice Address - Country:US
Practice Address - Phone:218-885-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3601103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling