Provider Demographics
NPI:1972895191
Name:BETTI, MICHAEL LYNN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:MICHAEL
Middle Name:LYNN
Last Name:BETTI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 1/2 WESTWOOD BLVD
Mailing Address - Street 2:7
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8414
Mailing Address - Country:US
Mailing Address - Phone:310-428-6773
Mailing Address - Fax:
Practice Address - Street 1:1949 1/2 WESTWOOD BLVD
Practice Address - Street 2:7
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8414
Practice Address - Country:US
Practice Address - Phone:310-428-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44936106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist