Provider Demographics
NPI:1881438901
Name:BETSIHA, BENIAM ASTER MEGABI AWOKE
Entity type:Individual
Prefix:
First Name:BENIAM
Middle Name:ASTER MEGABI AWOKE
Last Name:BETSIHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 BELT LINE RD # 451011
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-7106
Mailing Address - Country:US
Mailing Address - Phone:903-900-0023
Mailing Address - Fax:866-477-2772
Practice Address - Street 1:2213 WINDY DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-7553
Practice Address - Country:US
Practice Address - Phone:903-900-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1725464101Y00000X
TX16532101YA0400X
TX90504101YP2500X, 101YM0800X
477427225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor