Provider Demographics
NPI:1316027477
Name:EITEL, BETTY J (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:J
Last Name:EITEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 NE LOOP 820
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4634
Mailing Address - Country:US
Mailing Address - Phone:817-905-1277
Mailing Address - Fax:817-887-5821
Practice Address - Street 1:700 NE LOOP 820
Practice Address - Street 2:SUITE 200A
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4634
Practice Address - Country:US
Practice Address - Phone:817-905-1277
Practice Address - Fax:817-887-5821
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31363103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87118AOtherBCBS
TXQ34910Medicare UPIN
TX00814ZMedicare ID - Type Unspecified