Provider Demographics
NPI:1821151630
Name:HODEL, BETTINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:
Last Name:HODEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 OSPREY CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9813
Mailing Address - Country:US
Mailing Address - Phone:805-434-9220
Mailing Address - Fax:
Practice Address - Street 1:125 SERRANO HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1748
Practice Address - Country:US
Practice Address - Phone:805-286-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00201584OtherRAILROAD MEDICARE
CAP00201584OtherRAILROAD MEDICARE
CAQ24372Medicare UPIN