Provider Demographics
NPI:1881084960
Name:BELSBY, KEVIN (MDIV; THM; DMIN)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:BELSBY
Suffix:
Gender:M
Credentials:MDIV; THM; DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 BALBOA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1611
Mailing Address - Country:US
Mailing Address - Phone:818-521-6477
Mailing Address - Fax:
Practice Address - Street 1:41765 12TH ST W
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1422
Practice Address - Country:US
Practice Address - Phone:661-940-4861
Practice Address - Fax:661-942-4511
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT32075106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist