Healthcare Provider Details

I. General information

NPI: 1497104012
Provider Name (Legal Business Name): KARLY BELLICH LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2016
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12224 ROGER LN
DES PERES MO
63131-4321
US

IV. Provider business mailing address

1733 W WOODBINE AVE
KIRKWOOD MO
63122-5351
US

V. Phone/Fax

Practice location:
  • Phone: 309-242-2917
  • Fax:
Mailing address:
  • Phone: 309-242-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180010306
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: