Individual
DOUGLAS BELLAMY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
17762 PRESTON RD, DALLAS, TX 75252-5736
(972) 404-8888
(972) 208-2412
Mailing address
PO BOX 940165, PLANO, TX 75094-0165
(972) 424-9212
(972) 509-1450
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
21998
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038966001
—
TX
01
—
21998
STATE LICENSE
TX
01
—
4108749
AETNA ID
TX
01
—
81618P
BLUE CROSS ID
TX
01
—
OP21998
WC ID
TX
Enumeration date
03/08/2007
Last updated
04/05/2013
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