Provider Demographics
NPI:1437657749
Name:BETTS, SUSAN DENVER
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DENVER
Last Name:BETTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W 500 S STE 9
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2912
Mailing Address - Country:US
Mailing Address - Phone:435-725-6300
Mailing Address - Fax:435-725-6325
Practice Address - Street 1:285 W 800 S
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3707
Practice Address - Country:US
Practice Address - Phone:435-725-6300
Practice Address - Fax:435-725-6325
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 104100000X
UT11921481-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker