Provider Demographics
NPI:1790709137
Name:BETTISON AND BETTISON OF TEXAS INC.
Entity Type:Organization
Organization Name:BETTISON AND BETTISON OF TEXAS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:BETTISON
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW,SAP
Authorized Official - Phone:512-692-9327
Mailing Address - Street 1:4107 MEDICAL PKWY
Mailing Address - Street 2:SUITE 216
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3735
Mailing Address - Country:US
Mailing Address - Phone:512-692-9327
Mailing Address - Fax:713-244-0059
Practice Address - Street 1:4107 MEDICAL PKWY
Practice Address - Street 2:SUITE 216
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3735
Practice Address - Country:US
Practice Address - Phone:512-692-9327
Practice Address - Fax:713-244-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174035901Medicaid
TX174035901Medicaid