Healthcare Provider Details

I. General information

NPI: 1346133519
Provider Name (Legal Business Name): MICHAELA BELLEFY MSW, LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA ANTTILA

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9245 QUANTRELLE AVE NE
OTSEGO MN
55330-0168
US

IV. Provider business mailing address

605 19TH ST NW
BEMIDJI MN
56601-2541
US

V. Phone/Fax

Practice location:
  • Phone: 763-746-9492
  • Fax: 763-746-3685
Mailing address:
  • Phone: 701-308-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number31813
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: