Provider Demographics
NPI:1760574156
Name:BLUE, BETTY RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:RUTH
Last Name:BLUE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12842 VALLEY VIEW ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845-2517
Mailing Address - Country:US
Mailing Address - Phone:714-826-7650
Mailing Address - Fax:
Practice Address - Street 1:12842 VALLEY VIEW ST
Practice Address - Street 2:SUITE 201
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-2517
Practice Address - Country:US
Practice Address - Phone:714-826-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8153103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical