Provider Demographics
NPI:1891313219
Name:BELMONTE, LAURA (BCBA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BELMONTE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 COUNTY ROAD 2608
Mailing Address - Street 2:
Mailing Address - City:CADDO MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:75135-6277
Mailing Address - Country:US
Mailing Address - Phone:214-505-9814
Mailing Address - Fax:
Practice Address - Street 1:4325 COUNTY ROAD 2608
Practice Address - Street 2:
Practice Address - City:CADDO MILLS
Practice Address - State:TX
Practice Address - Zip Code:75135-6277
Practice Address - Country:US
Practice Address - Phone:214-505-9814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-44638103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty