Provider Demographics
NPI:1295131969
Name:BELTON, MARYANNE (PSYD)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:BELTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5930 E PIMA ST STE 138
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4351
Mailing Address - Country:US
Mailing Address - Phone:520-441-4006
Mailing Address - Fax:855-249-5320
Practice Address - Street 1:5930 E PIMA ST STE 138
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4351
Practice Address - Country:US
Practice Address - Phone:520-441-4006
Practice Address - Fax:855-249-5320
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY00-4572103TC0700X
AZ4572174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical