Provider Demographics
NPI:1760530984
Name:BETTNER, BETTY LOU - (PHD LPC)
Entity Type:Individual
Prefix:DR
First Name:BETTY LOU
Middle Name:-
Last Name:BETTNER
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STATE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1574
Mailing Address - Country:US
Mailing Address - Phone:610-566-1004
Mailing Address - Fax:610-566-1004
Practice Address - Street 1:1 STATE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1574
Practice Address - Country:US
Practice Address - Phone:610-566-1004
Practice Address - Fax:610-566-1004
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001939103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist