Provider Demographics
NPI:1013464262
Name:BETTLEY, AMBER MARIE
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MARIE
Last Name:BETTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:PICARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15095 AMARGOSA RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1879
Mailing Address - Country:US
Mailing Address - Phone:760-245-4695
Mailing Address - Fax:
Practice Address - Street 1:15095 AMARGOSA RD
Practice Address - Street 2:SUITE 208
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1879
Practice Address - Country:US
Practice Address - Phone:760-245-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist