Provider Demographics
NPI:1790316727
Name:BETTINGER, MALINDA LEAH (LCSW)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:LEAH
Last Name:BETTINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MALINDA
Other - Middle Name:LEAH
Other - Last Name:LEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:4215 BENTTREE DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8669
Mailing Address - Country:US
Mailing Address - Phone:270-926-4635
Mailing Address - Fax:270-926-4636
Practice Address - Street 1:4215 BENTTREE DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8669
Practice Address - Country:US
Practice Address - Phone:270-926-4635
Practice Address - Fax:270-926-4636
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY253100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health