Provider Demographics
NPI:1467537225
Name:SPECIA, BETTSIE E (LCSW LMFT)
Entity Type:Individual
Prefix:
First Name:BETTSIE
Middle Name:E
Last Name:SPECIA
Suffix:
Gender:F
Credentials:LCSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8301 BROADWAY ST
Mailing Address - Street 2:STE 112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2066
Mailing Address - Country:US
Mailing Address - Phone:210-821-5980
Mailing Address - Fax:210-821-6121
Practice Address - Street 1:8301 BROADWAY ST
Practice Address - Street 2:STE 112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2066
Practice Address - Country:US
Practice Address - Phone:210-821-5980
Practice Address - Fax:210-821-6121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS03925104100000X
TX3226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064237301Medicaid
TX064237301Medicaid