MEDICARE: DR. KRISTEN CLINE BELLONI PH.D., LP, LSSP

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	103T00000X	Psychologist	36646	TX

General Provider Information

NPI Number	:	1427461300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN CLINE BELLONI PH.D., LP, LSSP

Provider Business Mailing Address
First Line	:	8668 JOHN HICKMAN PKWY STE 804
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-9386
Country	:	US
Telephone Number	:	469-664-0070
Fax Number	:	469-200-8070

Provider Business Practice Location Address
First Line	:	8668 JOHN HICKMAN PKWY STE 804
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-9386
Country	:	US
Telephone Number	:	469-664-0070
Fax Number	:	469-200-8070

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

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	03/10/2021

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