Provider Demographics
NPI:1659861755
Name:BETANCOURT, AMPARO
Entity Type:Individual
Prefix:
First Name:AMPARO
Middle Name:
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MCKINLEY ST APT 6
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4074
Mailing Address - Country:US
Mailing Address - Phone:318-791-0205
Mailing Address - Fax:318-582-5646
Practice Address - Street 1:1204 STUBBS AVE STE B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-5631
Practice Address - Country:US
Practice Address - Phone:318-582-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator