Healthcare Provider Details

I. General information

NPI: 1821155979
Provider Name (Legal Business Name): ALAN DALE BELCHER M.S., L.M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 MCHENRY AVE
WOODSTOCK IL
60098-2922
US

IV. Provider business mailing address

2810 BOERDERIJ WAY
WOODSTOCK IL
60098-7613
US

V. Phone/Fax

Practice location:
  • Phone: 815-334-0411
  • Fax: 815-334-0413
Mailing address:
  • Phone: 815-338-7689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: