Provider Demographics
NPI:1669071635
Name:BELTON, KALEY JO
Entity type:Individual
Prefix:
First Name:KALEY
Middle Name:JO
Last Name:BELTON
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 1:11165 E DR S
Mailing Address - Street 2:
Mailing Address - City:CERESCO
Mailing Address - State:MI
Mailing Address - Zip Code:49033-9788
Mailing Address - Country:US
Mailing Address - Phone:269-213-6267
Mailing Address - Fax:
Practice Address - Street 1:11165 E DR S
Practice Address - Street 2:
Practice Address - City:CERESCO
Practice Address - State:MI
Practice Address - Zip Code:49033-9788
Practice Address - Country:US
Practice Address - Phone:269-213-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician