MEDICARE: HEAVENLEE M BELGARDE

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	103TA0700X	Adult Development & Aging Psychologist		ND

General Provider Information

NPI Number	:	1386508828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEAVENLEE M BELGARDE

Provider Business Mailing Address
First Line	:	PO BOX 273
Second Line	:
City	:	SAINT JOHN
State	:	ND
Zip	:	58369-0273
Country	:	US
Telephone Number	:	701-263-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 273
Second Line	:
City	:	SAINT JOHN
State	:	ND
Zip	:	58369-0273
Country	:	US
Telephone Number	:	701-263-1513
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ HEAVENLEE M BELGARDE ” Practice Location

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