Provider Demographics
NPI:1871637322
Name:DARBY, BETTY LEE (PHD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:LEE
Last Name:DARBY
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 1:1356 SIERRY PEAKS DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5155
Mailing Address - Country:US
Mailing Address - Phone:928-443-7440
Mailing Address - Fax:
Practice Address - Street 1:1129 W IRON SPRINGS RD
Practice Address - Street 2:#213
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1623
Practice Address - Country:US
Practice Address - Phone:928-777-2372
Practice Address - Fax:928-777-2361
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA853103TC0700X
AZ3590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0618820OtherBLUE CROSS PROVIDER #