Provider Demographics
NPI:1699819904
Name:BETTICH, CONNIE JEANNE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:JEANNE
Last Name:BETTICH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 BURNING TREE CIR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-4021
Mailing Address - Country:US
Mailing Address - Phone:863-471-0586
Mailing Address - Fax:
Practice Address - Street 1:1210 US 27 N
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7948
Practice Address - Country:US
Practice Address - Phone:863-465-3777
Practice Address - Fax:863-699-4339
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH5082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health