MEDICARE: BETTY KO JD, MA, LPC-A

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	101YP2500X	Professional Counselor	89433	TX

General Provider Information

NPI Number	:	1225742497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY KO JD, MA, LPC-A

Provider Business Mailing Address
First Line	:	4350 OCEAN DR APT 305
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78412-2569
Country	:	US
Telephone Number	:	361-728-3556
Fax Number	:

Provider Business Practice Location Address
First Line	:	6629 WOOLDRIDGE RD
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78414-2909
Country	:	US
Telephone Number	:	361-986-8263
Fax Number	:

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

Provider Enumeration Date	:	01/11/2023
Last Update Date	:	01/11/2023

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