Healthcare Provider Details

I. General information

NPI: 1982205373
Provider Name (Legal Business Name): JESSICA BELTER LCSW PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 E ELM ST # 1
TUCSON AZ
85716-3124
US

IV. Provider business mailing address

3009 E ELM ST # 1
TUCSON AZ
85716-3124
US

V. Phone/Fax

Practice location:
  • Phone: 520-500-7908
  • Fax:
Mailing address:
  • Phone: 520-500-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BELTER
Title or Position: PRESIDENT
Credential:
Phone: 520-500-7908