Provider Demographics
NPI:1417154121
Name:LONG, BETTE SHELDON (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTE
Middle Name:SHELDON
Last Name:LONG
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 1:100 ARAPAHOE AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5854
Mailing Address - Country:US
Mailing Address - Phone:303-546-2728
Mailing Address - Fax:303-413-1203
Practice Address - Street 1:100 ARAPAHOE AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5854
Practice Address - Country:US
Practice Address - Phone:303-546-2728
Practice Address - Fax:303-413-1203
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical