Provider Demographics
NPI:1952905929
Name:BETZ, ALEX (PMHNP)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:BETZ
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 N WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:OH
Mailing Address - Zip Code:43558-9581
Mailing Address - Country:US
Mailing Address - Phone:419-205-7330
Mailing Address - Fax:
Practice Address - Street 1:3130 EXECUTIVE PKWY FL 8
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5530
Practice Address - Country:US
Practice Address - Phone:419-720-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.00280902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry