Provider Demographics
NPI:1134309909
Name:GUDZ, BETSY (BA, CDP)
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:
Last Name:GUDZ
Suffix:
Gender:F
Credentials:BA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1553
Mailing Address - Street 2:7972 SE MAPLE AVENUE
Mailing Address - City:SNOQUALMIE
Mailing Address - State:WA
Mailing Address - Zip Code:98065-1553
Mailing Address - Country:US
Mailing Address - Phone:425-888-4151
Mailing Address - Fax:425-888-1064
Practice Address - Street 1:7972 MAPLE AVE SE
Practice Address - Street 2:
Practice Address - City:SNOQUALMIE
Practice Address - State:WA
Practice Address - Zip Code:98065
Practice Address - Country:US
Practice Address - Phone:425-888-4151
Practice Address - Fax:425-888-1064
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00005218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)