Provider Demographics
NPI:1558158261
Name:BETTS, VIVIAN (CADC INTERN)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:BETTS
Suffix:
Gender:
Credentials:CADC INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HARRIS ST APT 1424
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-6170
Mailing Address - Country:US
Mailing Address - Phone:702-574-5212
Mailing Address - Fax:
Practice Address - Street 1:2465 E TWAIN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-4011
Practice Address - Country:US
Practice Address - Phone:702-789-6201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07947-I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty