Provider Demographics
NPI:1669802658
Name:BETTINO COUNSELING
Entity type:Organization
Organization Name:BETTINO COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BETTINO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:928-772-4185
Mailing Address - Street 1:8430 E SPOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-6142
Mailing Address - Country:US
Mailing Address - Phone:928-772-4185
Mailing Address - Fax:
Practice Address - Street 1:8430 E SPOUSE DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-6142
Practice Address - Country:US
Practice Address - Phone:928-772-4185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0033101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1184714503OtherNPI