Provider Demographics
NPI:1225742497
Name:KO, BETTY (JD, MA, LPC-A)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:KO
Suffix:
Gender:F
Credentials:JD, MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4350 OCEAN DR APT 305
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-2569
Mailing Address - Country:US
Mailing Address - Phone:361-728-3556
Mailing Address - Fax:
Practice Address - Street 1:6629 WOOLDRIDGE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2909
Practice Address - Country:US
Practice Address - Phone:361-986-8263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional