Provider Demographics
NPI:1588004782
Name:GERALD BETZEN MFT, INC.
Entity Type:Organization
Organization Name:GERALD BETZEN MFT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BETZEN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:310-271-2001
Mailing Address - Street 1:337 S BEVERLY DR
Mailing Address - Street 2:STE. 207
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4315
Mailing Address - Country:US
Mailing Address - Phone:310-271-2001
Mailing Address - Fax:310-843-9864
Practice Address - Street 1:337 S BEVERLY DR
Practice Address - Street 2:STE. 207
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4315
Practice Address - Country:US
Practice Address - Phone:310-271-2001
Practice Address - Fax:310-843-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33284251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health