Provider Demographics
NPI:1164762977
Name:DESILETS, BETH
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DESILETS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:DESILETS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1901 E. 37TH, STE 104
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762
Mailing Address - Country:US
Mailing Address - Phone:432-333-3667
Mailing Address - Fax:432-580-3115
Practice Address - Street 1:1901 E 37TH ST STE 104
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-6210
Practice Address - Country:US
Practice Address - Phone:432-333-3667
Practice Address - Fax:432-580-3115
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional