Provider Demographics
NPI:1760718647
Name:BETTENCOURT, JEFFREY EUGENE (LMFT;LEP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:EUGENE
Last Name:BETTENCOURT
Suffix:
Gender:M
Credentials:LMFT;LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18181 BUTTERFIELD BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-8119
Mailing Address - Country:US
Mailing Address - Phone:408-203-4401
Mailing Address - Fax:
Practice Address - Street 1:18181 BUTTERFIELD BLVD STE 105
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-8119
Practice Address - Country:US
Practice Address - Phone:408-203-4401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2986103TS0200X
CA29912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA299122986OtherBBS