Provider Demographics
NPI:1760784755
Name:BETTIS, GODWIN EARL (LCDC)
Entity Type:Individual
Prefix:MR
First Name:GODWIN
Middle Name:EARL
Last Name:BETTIS
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 PLEASANT VALLEY LN STE B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2906
Mailing Address - Country:US
Mailing Address - Phone:817-557-6880
Mailing Address - Fax:817-557-6841
Practice Address - Street 1:3210 PLEASANT VALLEY LN STE B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2906
Practice Address - Country:US
Practice Address - Phone:817-557-6880
Practice Address - Fax:817-557-6841
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4485101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)