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NPI Code Detail

MEDICARE: JACKLYN F BELDEN L.P.C.

MEDICARE: JACKLYN F BELDEN L.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor17992TX
2101YP2500XProfessional Counselor17992TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1043409634
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACKLYN F BELDEN L.P.C.
Provider Business Mailing Address
First Line : 3131 SANGUINET ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-5336
Country : US
Telephone Number : 817-235-5747
Fax Number : 817-569-4517
Provider Business Practice Location Address
First Line : 3131 SANGUINET ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-5336
Country : US
Telephone Number : 817-235-5747
Fax Number : 817-569-4517
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2007
Last Update Date : 03/18/2019

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