Provider Demographics
NPI:1538303474
Name:BETZ KING PC
Entity Type:Organization
Organization Name:BETZ KING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETZ
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:248-417-7755
Mailing Address - Street 1:26105 ORCHARD LAKE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4578
Mailing Address - Country:US
Mailing Address - Phone:248-788-5798
Mailing Address - Fax:866-810-8008
Practice Address - Street 1:26105 ORCHARD LAKE RD STE 203
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-4578
Practice Address - Country:US
Practice Address - Phone:248-417-7755
Practice Address - Fax:248-478-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOMI1860Medicaid