Provider Demographics
NPI:1699345801
Name:BELT, SHASTA KAYLEE
Entity type:Individual
Prefix:
First Name:SHASTA
Middle Name:KAYLEE
Last Name:BELT
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 1:1721 N DELANO ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MI
Mailing Address - Zip Code:48079-5268
Mailing Address - Country:US
Mailing Address - Phone:619-850-7231
Mailing Address - Fax:
Practice Address - Street 1:22600 HALL RD STE 201
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1173
Practice Address - Country:US
Practice Address - Phone:586-996-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist