Provider Demographics
NPI:1477875417
Name:BETTS, STEPHANIE DAWN (CADC, UNDER SUPERVIS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:DAWN
Last Name:BETTS
Suffix:
Gender:F
Credentials:CADC, UNDER SUPERVIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73702-0641
Mailing Address - Country:US
Mailing Address - Phone:580-747-3844
Mailing Address - Fax:580-234-8820
Practice Address - Street 1:404 N GRAND ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3215
Practice Address - Country:US
Practice Address - Phone:580-234-8222
Practice Address - Fax:580-234-8820
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)