Provider Demographics
NPI:1114922242
Name:ACREE, BETTY (MS)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:ACREE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 E BROADWAY
Mailing Address - Street 2:STE 313
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-6082
Mailing Address - Country:US
Mailing Address - Phone:573-256-2914
Mailing Address - Fax:
Practice Address - Street 1:2100 E BROADWAY
Practice Address - Street 2:STE 313
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6082
Practice Address - Country:US
Practice Address - Phone:573-256-2914
Practice Address - Fax:573-256-6214
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001077101YP2500X
MO300125106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO142919OtherBLUE CROSS BLUE SHIELD