Provider Demographics
NPI:1184435687
Name:JEPSEN, BETSY R (T-LMFT)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:R
Last Name:JEPSEN
Suffix:
Gender:F
Credentials:T-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 NE BOWMAN DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-5033
Mailing Address - Country:US
Mailing Address - Phone:515-210-5109
Mailing Address - Fax:
Practice Address - Street 1:5415 NW 88TH ST STE 100
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2951
Practice Address - Country:US
Practice Address - Phone:515-727-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist