Provider Demographics
NPI:1114161148
Name:BETCHWARS, CARLA J (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:J
Last Name:BETCHWARS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 WEIR DR
Mailing Address - Street 2:SUITE 355
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2272
Mailing Address - Country:US
Mailing Address - Phone:651-254-8580
Mailing Address - Fax:
Practice Address - Street 1:1811 WEIR DR
Practice Address - Street 2:SUITE 355
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2272
Practice Address - Country:US
Practice Address - Phone:651-254-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1690106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist