Provider Demographics
NPI:1306226600
Name:BELCOURT, JASON TYLER
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TYLER
Last Name:BELCOURT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 GEORGIA AVE SUITE 106
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-9429
Mailing Address - Country:US
Mailing Address - Phone:803-426-9805
Mailing Address - Fax:
Practice Address - Street 1:1305 GEORGIA AVE SUITE 106
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-9429
Practice Address - Country:US
Practice Address - Phone:803-426-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6123101YP2500X, 101Y00000X
CT2651101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional