Provider Demographics
NPI:1972384345
Name:BETZ, LYDIA GRACE (MT-BC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:GRACE
Last Name:BETZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 SUNNY MEADE CT NE APT 302
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2092
Mailing Address - Country:US
Mailing Address - Phone:734-646-9924
Mailing Address - Fax:
Practice Address - Street 1:11650 DOWNES ST NE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9489
Practice Address - Country:US
Practice Address - Phone:616-897-7842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
18153225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist