Doctor Name: | MR. EMMET F. BELLVILLE |
NPI Number: | 1033250352 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA, MA |
License Number: | 4358 |
Business Practice Address: | 924 Indiana Ave Pueblo, CO - 810043747 |
Business Phone Number: | 7195649039 |
Business Fax Number: | |
Mailing Address: | 417 E Kiowa St Unit 207, COLORADO SPRINGS |
State: | CO |
Postal Code: | 809033455 |
Phone Number: | 7192502333 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 4358 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |