Provider Demographics
NPI:1467068593
Name:BETTS, TIMARA D
Entity Type:Individual
Prefix:MRS
First Name:TIMARA
Middle Name:D
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 1:2824 142ND PL
Mailing Address - Street 2:
Mailing Address - City:BLUE ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60406-4190
Mailing Address - Country:US
Mailing Address - Phone:708-466-7600
Mailing Address - Fax:
Practice Address - Street 1:1 N DEARBORN ST # 100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4331
Practice Address - Country:US
Practice Address - Phone:708-216-0372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker