Provider Demographics
NPI:1801809611
Name:BELLER, JAMES E (MA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BELLER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 JAZZ DR
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4906
Mailing Address - Country:US
Mailing Address - Phone:850-522-9719
Mailing Address - Fax:850-522-9718
Practice Address - Street 1:105 JAZZ DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4906
Practice Address - Country:US
Practice Address - Phone:850-522-9719
Practice Address - Fax:850-522-9718
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1636101YM0800X
FLMT1166106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ4397OtherBLUE CROSS BLUE SHIELD