Provider Demographics
NPI:1033150834
Name:BETTOR, LAURA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:BETTOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5720 REPUBLIC OF TEXAS BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6512
Mailing Address - Country:US
Mailing Address - Phone:512-971-7819
Mailing Address - Fax:
Practice Address - Street 1:1310 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-3056
Practice Address - Country:US
Practice Address - Phone:512-971-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-5215103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040767801Medicaid
TX680014218OtherRAILROAD MEDICARE
TX86338AOtherBLUE CROSS BLUE SHIELD
TX82701PMedicare ID - Type Unspecified