Provider Demographics
NPI:1831067586
Name:BETANCOURT, STACIE MICHELE (PHD)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:MICHELE
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9222 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5148
Mailing Address - Country:US
Mailing Address - Phone:909-733-2346
Mailing Address - Fax:
Practice Address - Street 1:9222 SVL BOX
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5148
Practice Address - Country:US
Practice Address - Phone:909-733-2346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAAB2C399BB171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach