Provider Demographics
NPI:1619691052
Name:STOCK, BETSEE RENEE (MED, NCC)
Entity Type:Individual
Prefix:
First Name:BETSEE
Middle Name:RENEE
Last Name:STOCK
Suffix:
Gender:F
Credentials:MED, NCC
Other - Prefix:
Other - First Name:BETSEE
Other - Middle Name:RENEE
Other - Last Name:BEUNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:638 FERNDALE AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3946
Mailing Address - Country:US
Mailing Address - Phone:814-288-4961
Mailing Address - Fax:
Practice Address - Street 1:638 FERNDALE AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3946
Practice Address - Country:US
Practice Address - Phone:814-288-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional