Provider Demographics
NPI:1710160536
Name:BETZ, STEPHAN JOHANNNES (MTBC, CGP)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:JOHANNNES
Last Name:BETZ
Suffix:
Gender:M
Credentials:MTBC, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 BECK AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6804
Mailing Address - Country:US
Mailing Address - Phone:707-784-8400
Mailing Address - Fax:707-421-3207
Practice Address - Street 1:275 BECK AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6804
Practice Address - Country:US
Practice Address - Phone:707-784-8400
Practice Address - Fax:707-421-3207
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM72451101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor