Provider Demographics
NPI:1568851863
Name:BETZ-MUNCY, SHERYL LYNNE (ASSOCIATE MARRIAGE F)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:LYNNE
Last Name:BETZ-MUNCY
Suffix:
Gender:F
Credentials:ASSOCIATE MARRIAGE F
Other - Prefix:MRS
Other - First Name:SHERYL
Other - Middle Name:LYNNE
Other - Last Name:LETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFTI
Mailing Address - Street 1:5305 TENNIS CT
Mailing Address - Street 2:
Mailing Address - City:WEED
Mailing Address - State:CA
Mailing Address - Zip Code:96094-9369
Mailing Address - Country:US
Mailing Address - Phone:530-262-5761
Mailing Address - Fax:
Practice Address - Street 1:1107 REAM AVE
Practice Address - Street 2:
Practice Address - City:MOUNT SHASTA
Practice Address - State:CA
Practice Address - Zip Code:96067-9768
Practice Address - Country:US
Practice Address - Phone:530-841-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-10
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF82639106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist