Provider Demographics
NPI:1114749843
Name:BELLER, KEN (AC)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:BELLER
Suffix:
Gender:M
Credentials:AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 RED ROCK CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-9761
Mailing Address - Country:US
Mailing Address - Phone:928-204-9232
Mailing Address - Fax:928-204-9230
Practice Address - Street 1:75 RED ROCK CROSSING RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-9761
Practice Address - Country:US
Practice Address - Phone:928-204-9232
Practice Address - Fax:928-204-9230
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach