Provider Demographics
NPI:1851033005
Name:BELTZ, KALI
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:BELTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIVER
Other - Middle Name:
Other - Last Name:BELTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3409 LARIAT LN APT 13
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2834
Mailing Address - Country:US
Mailing Address - Phone:248-275-7571
Mailing Address - Fax:
Practice Address - Street 1:1551 BOREN DR STE C
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2966
Practice Address - Country:US
Practice Address - Phone:407-223-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-206220106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician