Provider Demographics
NPI:1710171731
Name:BETTS-JIMENEZ, ISSIS M (MA)
Entity Type:Individual
Prefix:MRS
First Name:ISSIS
Middle Name:M
Last Name:BETTS-JIMENEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA SOMERSET CLINIC
Mailing Address - Street 2:163 TOWER CIR
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-676-0786
Mailing Address - Fax:
Practice Address - Street 1:VA SOMERSET CLINIC
Practice Address - Street 2:163 TOWER CIR
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-676-0786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-03
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9779-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical