Provider Demographics
NPI:1033278262
Name:BETTS, KENNETH RAY (LPCMH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:RAY
Last Name:BETTS
Suffix:
Gender:M
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25197 BETHESDA RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-2546
Mailing Address - Country:US
Mailing Address - Phone:302-424-7425
Mailing Address - Fax:
Practice Address - Street 1:12649 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:ELLENDALE
Practice Address - State:DE
Practice Address - Zip Code:19941-3307
Practice Address - Country:US
Practice Address - Phone:302-424-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC 0000336101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036552Medicaid