Provider Demographics
NPI:1194164921
Name:BELKNAP, CAROLYN JEAN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEAN
Last Name:BELKNAP
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 1:1022 LINDELL AVE
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-3230
Mailing Address - Country:US
Mailing Address - Phone:231-439-8354
Mailing Address - Fax:
Practice Address - Street 1:1022 LINDELL AVE
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-3230
Practice Address - Country:US
Practice Address - Phone:231-439-8354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401009177OtherPROFESSIONAL COUNSELOR LICENSE