Provider Demographics
NPI:1336173384
Name:JODER, BETTY J (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:JODER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 PARK AVE
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2831
Mailing Address - Country:US
Mailing Address - Phone:831-475-1797
Mailing Address - Fax:831-423-6770
Practice Address - Street 1:2901 PARK AVE
Practice Address - Street 2:SUITE A-1
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2831
Practice Address - Country:US
Practice Address - Phone:831-475-1797
Practice Address - Fax:831-423-6770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 37537106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist