Provider Demographics
NPI:1881729416
Name:RUNNELS, BETTY L (MA, LMFT)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 1ST ST
Mailing Address - Street 2:254
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-7361
Mailing Address - Country:US
Mailing Address - Phone:925-989-5620
Mailing Address - Fax:
Practice Address - Street 1:4713 1ST ST
Practice Address - Street 2:254
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7361
Practice Address - Country:US
Practice Address - Phone:925-989-5620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44811106H00000X
IL166000747106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist