Provider Demographics
NPI:1336833706
Name:BELLANT, ASHLEY JEAN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JEAN
Last Name:BELLANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2404
Mailing Address - Country:US
Mailing Address - Phone:504-330-8429
Mailing Address - Fax:
Practice Address - Street 1:3800 HERITAGE AVE STE A2
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2871
Practice Address - Country:US
Practice Address - Phone:517-204-4670
Practice Address - Fax:517-347-9622
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851116248104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker