Provider Demographics
NPI:1053463133
Name:BETTISON, JOHN CALVIN SR (MSW, LCSW SAP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CALVIN
Last Name:BETTISON
Suffix:SR
Gender:M
Credentials:MSW, LCSW SAP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4107 MEDICAL PKWY # 6929327
Mailing Address - Street 2:SUITE 216
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3735
Mailing Address - Country:US
Mailing Address - Phone:512-692-9327
Mailing Address - Fax:713-244-0059
Practice Address - Street 1:4107 MEDICAL PKWY # 6929327
Practice Address - Street 2:SUITE 216
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3735
Practice Address - Country:US
Practice Address - Phone:512-692-9327
Practice Address - Fax:713-244-0059
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX370911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158552304Medicaid
TX8F0161Medicare ID - Type Unspecified