Provider Demographics
NPI:1801900915
Name:TETU, BETTY (CAC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:TETU
Suffix:
Gender:F
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 CREED ST
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5139
Mailing Address - Country:US
Mailing Address - Phone:318-451-0481
Mailing Address - Fax:318-487-5703
Practice Address - Street 1:UNIT 6 MEADOW LANE
Practice Address - Street 2:CLSH RED RIVER TREATMENT CENTER
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360
Practice Address - Country:US
Practice Address - Phone:318-484-6400
Practice Address - Fax:318-487-5703
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACAC 1007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)