Provider Demographics
NPI:1659492395
Name:BETTIS, REBECCA J (MASTERS DEGREE)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:J
Last Name:BETTIS
Suffix:
Gender:F
Credentials:MASTERS DEGREE
Other - Prefix:MS
Other - First Name:BECCA
Other - Middle Name:J
Other - Last Name:BETTIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTERS DEGREE
Mailing Address - Street 1:2861 FOX RUN RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95634-9709
Mailing Address - Country:US
Mailing Address - Phone:530-889-7221
Mailing Address - Fax:530-889-7293
Practice Address - Street 1:11512 B AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2605
Practice Address - Country:US
Practice Address - Phone:530-889-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YAO400XMedicare UPIN