Provider Demographics
NPI:1376374827
Name:BRENT BELFORD PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:BRENT BELFORD PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:BELFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:971-319-1676
Mailing Address - Street 1:4202 MERIDIAN ST STE 105-145
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8760
Mailing Address - Country:US
Mailing Address - Phone:971-319-1676
Mailing Address - Fax:
Practice Address - Street 1:4202 MERIDIAN ST STE 105-145
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8760
Practice Address - Country:US
Practice Address - Phone:971-319-1676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty