Provider Demographics
NPI:1407416050
Name:RUTAN, BETTE BROCK (LMHC)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:BROCK
Last Name:RUTAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CYPRESS HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3047
Mailing Address - Country:US
Mailing Address - Phone:386-366-4797
Mailing Address - Fax:
Practice Address - Street 1:19 CYPRESS HOLLOW LN
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-3047
Practice Address - Country:US
Practice Address - Phone:386-366-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health