Provider Demographics
NPI:1194263152
Name:BELLAMY, KATIE (LPC, R-DMT, MPAC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BELLAMY
Suffix:
Gender:F
Credentials:LPC, R-DMT, MPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 N CALIFORNIA AVE
Mailing Address - Street 2:#3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2636
Mailing Address - Country:US
Mailing Address - Phone:616-915-6105
Mailing Address - Fax:
Practice Address - Street 1:2535 N CALIFORNIA AVE
Practice Address - Street 2:#3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2636
Practice Address - Country:US
Practice Address - Phone:616-915-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional