Provider Demographics
NPI:1700571437
Name:BELLE, LIDIA
Entity type:Individual
Prefix:
First Name:LIDIA
Middle Name:
Last Name:BELLE
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 1:1711 E CENTRAL TEXAS EXPY STE 108-5
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9145
Mailing Address - Country:US
Mailing Address - Phone:254-462-9065
Mailing Address - Fax:254-237-8060
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 108-5
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9145
Practice Address - Country:US
Practice Address - Phone:254-462-9065
Practice Address - Fax:254-237-8060
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-07
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595261041C0700X
TX69526101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty