MEDICARE: KIMBERLY BELASCHKY M.ED., LPC, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-14-17637	TX
2	101YP2500X	Professional Counselor	70257	TX

General Provider Information

NPI Number	:	1093103822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY BELASCHKY M.ED., LPC, BCBA

Provider Business Mailing Address
First Line	:	23904 CROOKED CRK
Second Line	:
City	:	HOCKLEY
State	:	TX
Zip	:	77447-7541
Country	:	US
Telephone Number	:	281-905-8179
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 WELLS FARGO DR
Second Line	:	SUITE 12
City	:	HOUSTON
State	:	TX
Zip	:	77090-4060
Country	:	US
Telephone Number	:	317-334-7331
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/01/2015
Last Update Date	:	11/29/2016

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