MEDICARE: DR. BETZ KING PSY. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301013348	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11627369	OTHER	MI	CAQH

General Provider Information

NPI Number	:	1083833594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BETZ KING PSY. D

Provider Business Mailing Address
First Line	:	26105 ORCHARD LAKE RD
Second Line	:	SUITE 207
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4576
Country	:	US
Telephone Number	:	248-788-5798
Fax Number	:	248-957-8544

Provider Business Practice Location Address
First Line	:	26105 ORCHARD LAKE RD
Second Line	:	SUITE 207
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-4576
Country	:	US
Telephone Number	:	248-788-5798
Fax Number	:	248-957-8544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	01/23/2017

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