Basic Information
| Provider Information | |||||||||
| NPI: | 1285938944 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BELGUITH | ||||||||
| FirstName: | AMEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 SE 35TH PL | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972023365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944222 | ||||||||
| FaxNumber: | 5034948080 | ||||||||
| Practice Location | |||||||||
| Address1: | 3633 SE 35TH PL | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972023365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944222 | ||||||||
| FaxNumber: | 5034948080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2011 | ||||||||
| LastUpdateDate: | 01/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 248460 | 05 | OR | MEDICAID |