Provider Demographics
NPI:1003136029
Name:WEST BELFORT FAMILY PRACTICE
Entity type:Organization
Organization Name:WEST BELFORT FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:281-974-1723
Mailing Address - Street 1:8449 W BELFORT #220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071
Mailing Address - Country:US
Mailing Address - Phone:281-974-1723
Mailing Address - Fax:
Practice Address - Street 1:8449 W BELFORT
Practice Address - Street 2:220
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071
Practice Address - Country:US
Practice Address - Phone:281-974-1723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty