Healthcare Provider Details

I. General information

NPI: 1285032045
Provider Name (Legal Business Name): DAVID DEAN BELK NONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3871 FAIRVIEW INDUSTRIAL DR SE STE 150
SALEM OR
97302-1172
US

IV. Provider business mailing address

3871 FAIRVIEW INDUSTRIAL DR SE STE 150
SALEM OR
97302-1172
US

V. Phone/Fax

Practice location:
  • Phone: 503-391-9762
  • Fax: 503-315-2019
Mailing address:
  • Phone: 503-391-9762
  • Fax: 503-315-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: