Provider Demographics
NPI:1790083574
Name:VICKERS, BETSY LYNN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BETSY
Middle Name:LYNN
Last Name:VICKERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 SLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8793
Mailing Address - Country:US
Mailing Address - Phone:517-944-0111
Mailing Address - Fax:
Practice Address - Street 1:5750 SLAYTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8793
Practice Address - Country:US
Practice Address - Phone:517-944-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801090038101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health