Provider Demographics
NPI:1154942084
Name:BELLE, MARTIE CAMILLE
Entity type:Individual
Prefix:
First Name:MARTIE
Middle Name:CAMILLE
Last Name:BELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 SOUTHWEST PKWY APT 1015
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-4767
Mailing Address - Country:US
Mailing Address - Phone:817-403-2924
Mailing Address - Fax:
Practice Address - Street 1:1462 CLIFTON RD NE STE 235
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1063
Practice Address - Country:US
Practice Address - Phone:817-403-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist