Provider Demographics
NPI:1760886022
Name:BETTON, KEVIN LURRELL SR (DMIN)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:LURRELL
Last Name:BETTON
Suffix:SR
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-3258
Mailing Address - Country:US
Mailing Address - Phone:912-876-6459
Mailing Address - Fax:912-876-6406
Practice Address - Street 1:406 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-3258
Practice Address - Country:US
Practice Address - Phone:912-876-6459
Practice Address - Fax:912-876-6406
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral