Provider Demographics
NPI:1396947040
Name:LEMOS, BETTY MARIE (MFT)
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:MARIE
Last Name:LEMOS
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 1:9541 GROSSMONT SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9541 GROSSMONT SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-4105
Practice Address - Country:US
Practice Address - Phone:619-248-3067
Practice Address - Fax:619-741-3150
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2016-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41012106H00000X
CA60101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional