1093103822 NPI number — KIMBERLY BELASCHKY M.ED., LPC, BCBA

Table of content: KIMBERLY BELASCHKY M.ED., LPC, BCBA (NPI 1093103822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093103822 NPI number — KIMBERLY BELASCHKY M.ED., LPC, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELASCHKY
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIE
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., LPC, BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093103822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23904 CROOKED CRK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOCKLEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77447-7541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-905-8179
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 WELLS FARGO DR
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77090-4060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-334-7331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-14-17637 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: 70257 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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