Provider Demographics
NPI:1184773459
Name:THARPE, BETTY (MFT)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:THARPE
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 1:2612 ALCATRAZ AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2723
Mailing Address - Country:US
Mailing Address - Phone:510-655-1511
Mailing Address - Fax:510-338-6384
Practice Address - Street 1:2612 ALCATRAZ AVE STE 5
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2723
Practice Address - Country:US
Practice Address - Phone:510-655-1511
Practice Address - Fax:510-338-6384
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA134875OtherVALUE OPTIONS