Provider Demographics
NPI:1386508828
Name:BELGARDE, HEAVENLEE M
Entity type:Individual
Prefix:
First Name:HEAVENLEE
Middle Name:M
Last Name:BELGARDE
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:PO BOX 273
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:ND
Mailing Address - Zip Code:58369-0273
Mailing Address - Country:US
Mailing Address - Phone:701-263-1513
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 273
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:ND
Practice Address - Zip Code:58369-0273
Practice Address - Country:US
Practice Address - Phone:701-263-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging