Provider Demographics
NPI:1598264277
Name:BETTISON, LANCE BRANDON (MA, LLPC)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:BRANDON
Last Name:BETTISON
Suffix:
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 PARTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-3009
Mailing Address - Country:US
Mailing Address - Phone:269-823-4822
Mailing Address - Fax:269-383-9781
Practice Address - Street 1:157 S KALAMAZOO MALL STE 250
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-4828
Practice Address - Country:US
Practice Address - Phone:269-383-1440
Practice Address - Fax:269-383-9781
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional