=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659410181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES PATRICK BELLER M.A. L.M.H.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 04/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 BALLARD ST
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32701-5441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-758-0245
-----------------------------------------------------
Fax | 407-862-2737
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 517 DELTONA BLVD STE A
-----------------------------------------------------
City | DELTONA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32725-8016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-259-5413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | MH6626
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH6626
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------