Provider Demographics
NPI:1659604130
Name:MOLTER, BETTY ANN (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:ANN
Last Name:MOLTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 320
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92678-0320
Mailing Address - Country:US
Mailing Address - Phone:949-751-9369
Mailing Address - Fax:
Practice Address - Street 1:26451 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6362
Practice Address - Country:US
Practice Address - Phone:949-751-9369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 46277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist