Provider Demographics
NPI:1942310792
Name:BELT, JENNIFER LYNNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNNE
Last Name:BELT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:SAUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48842 RATTLE RUN DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-2319
Mailing Address - Country:US
Mailing Address - Phone:586-873-6029
Mailing Address - Fax:
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:SUITE 218
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:586-873-6029
Practice Address - Fax:586-948-8593
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005980101Y00000X
MI6301013859103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor