Provider Demographics
NPI:1457667545
Name:MAGNUS, BETTY J (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:J
Last Name:MAGNUS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15798 N RIMROCK RD
Mailing Address - Street 2:
Mailing Address - City:HAYDEN LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83835-7336
Mailing Address - Country:US
Mailing Address - Phone:208-772-5360
Mailing Address - Fax:
Practice Address - Street 1:15798 N RIMROCK RD
Practice Address - Street 2:
Practice Address - City:HAYDEN LAKE
Practice Address - State:ID
Practice Address - Zip Code:83835-7336
Practice Address - Country:US
Practice Address - Phone:208-772-5360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional