Provider Demographics
NPI:1497533921
Name:BETTING, DERRICK SHILO (LPCC)
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:SHILO
Last Name:BETTING
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 STEEPLE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:CO
Mailing Address - Zip Code:80516-9521
Mailing Address - Country:US
Mailing Address - Phone:208-724-3024
Mailing Address - Fax:
Practice Address - Street 1:2813 STEEPLE ROCK DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:CO
Practice Address - Zip Code:80516-9521
Practice Address - Country:US
Practice Address - Phone:208-724-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional