Provider Demographics
NPI:1205178993
Name:WITHERSPOON, BETTY JANE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:JANE
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N EASTMAN RD
Mailing Address - Street 2:VA CBOC
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-4231
Mailing Address - Country:US
Mailing Address - Phone:903-247-8262
Mailing Address - Fax:
Practice Address - Street 1:1005 N EASTMAN RD
Practice Address - Street 2:VA CBOC
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4231
Practice Address - Country:US
Practice Address - Phone:903-247-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54372104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker