Provider Demographics
NPI:1003427212
Name:MCCLOUD, BETRIA (HLP)
Entity type:Individual
Prefix:
First Name:BETRIA
Middle Name:
Last Name:MCCLOUD
Suffix:
Gender:F
Credentials:HLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7236 TWIN OAKS DR APT C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-5740
Mailing Address - Country:US
Mailing Address - Phone:317-506-4390
Mailing Address - Fax:
Practice Address - Street 1:2508 E 146TH ST STE 107
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7714
Practice Address - Country:US
Practice Address - Phone:317-506-4390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCI21700032224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
85-0824374OtherIRS