Provider Demographics
NPI:1992186084
Name:BLETZ, BETTY (LPC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:BLETZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 223
Mailing Address - Street 2:710 RAILROAD STREET
Mailing Address - City:BELCHER
Mailing Address - State:LA
Mailing Address - Zip Code:71004-0223
Mailing Address - Country:US
Mailing Address - Phone:318-995-4921
Mailing Address - Fax:
Practice Address - Street 1:710 RAILROAD STREET
Practice Address - Street 2:
Practice Address - City:BELCHER
Practice Address - State:LA
Practice Address - Zip Code:71004-0223
Practice Address - Country:US
Practice Address - Phone:318-995-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional