Healthcare Provider Details

I. General information

NPI: 1134689094
Provider Name (Legal Business Name): EMILY BREANN BELT BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 BROADWAY ST STE 101
PADUCAH KY
42001-0713
US

IV. Provider business mailing address

425 BROADWAY ST STE 101
PADUCAH KY
42001-0713
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-9767
  • Fax: 270-442-7923
Mailing address:
  • Phone: 270-442-9767
  • Fax: 270-442-7923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: