Provider Demographics
NPI:1649027376
Name:COMANCHE, BETTY (RAC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:COMANCHE
Suffix:
Gender:F
Credentials:RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 REDDIX LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-5949
Mailing Address - Country:US
Mailing Address - Phone:318-807-5086
Mailing Address - Fax:
Practice Address - Street 1:4600 REDDIX LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-5949
Practice Address - Country:US
Practice Address - Phone:318-807-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1043101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)