Provider Demographics
NPI:1073199139
Name:BETZELBERGER, TORIANNA
Entity Type:Individual
Prefix:
First Name:TORIANNA
Middle Name:
Last Name:BETZELBERGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12155 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8989
Mailing Address - Country:US
Mailing Address - Phone:312-660-2319
Mailing Address - Fax:616-323-3966
Practice Address - Street 1:12155 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8989
Practice Address - Country:US
Practice Address - Phone:312-660-2319
Practice Address - Fax:616-323-3966
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician