Individual provider Active NPI

Bethelhem Belachew

  • Clinical Child & Adolescent Psychologist
  • Dallas, TX
National Provider Identifier
1245075142
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
40136 Issued in TX
Practice address
1935 Medical District Dr
Dallas, TX 75235-7701
Phone
(214) 456-7000
NPI assigned
Jul 1, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 40136 TX Primary

Addresses

Primary practice location

1935 Medical District Dr
Dallas, TX 75235-7701

Mailing address

1935 Medical District Dr
Dallas, TX 75235-7701
Phone (214) 456-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250130003478 TX Practitioner - Clinical Psychologist 0446789788 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
40136TXMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Health System of Texas CurrentSince Jan 22, 2025 Accepting new patients
Children'S Health System of Texas CurrentSince Jan 22, 2025 Accepting new patients

Locations

1935 Medical District Dr
#908
Dallas, TX 75235

1935 Medical District Dr
Dallas, TX 75235
Phone (214) 456-2735

7601 Preston Rd
Plano, TX 75024
Phone (469) 303-7300

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1245075142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 MEDICAL DISTRICT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357701",
            "telephone_number": "214-456-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 MEDICAL DISTRICT DR",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752357701",
            "telephone_number": "214-456-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BELACHEW",
        "first_name": "BETHELHEM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-01",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "TX",
            "license": "40136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

Verify at the official NPI Registry.