Provider Demographics
NPI:1649987660
Name:BELTRAN, LETICIA (LCPC)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:BELTRAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16432 N MIDLAND BLVD # 226
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5222
Mailing Address - Country:US
Mailing Address - Phone:702-900-1649
Mailing Address - Fax:
Practice Address - Street 1:16432 N MIDLAND BLVD # 226
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5222
Practice Address - Country:US
Practice Address - Phone:702-900-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2025-01-02
Deactivation Date:2024-01-05
Deactivation Code:
Reactivation Date:2024-12-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health