Provider Demographics
NPI:1083833594
Name:KING, BETZ (PSY D)
Entity Type:Individual
Prefix:DR
First Name:BETZ
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26105 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4576
Mailing Address - Country:US
Mailing Address - Phone:248-788-5798
Mailing Address - Fax:248-957-8544
Practice Address - Street 1:26105 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 207
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4576
Practice Address - Country:US
Practice Address - Phone:248-788-5798
Practice Address - Fax:248-957-8544
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013348103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11627369OtherCAQH