Provider Demographics
NPI:1629406418
Name:THORNTON ROUNDS, BETTY JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:JANE
Last Name:THORNTON ROUNDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:BETTY
Other - Middle Name:JANE
Other - Last Name:ROUNDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1642 MCCULLOCH BLVD N
Mailing Address - Street 2:#185
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-0961
Mailing Address - Country:US
Mailing Address - Phone:928-208-3613
Mailing Address - Fax:928-854-1661
Practice Address - Street 1:1979 MCCULLOCH BLVD N
Practice Address - Street 2:SUITE 202
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-0953
Practice Address - Country:US
Practice Address - Phone:928-208-3613
Practice Address - Fax:928-854-1661
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-139911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical