MEDICARE: BROOKE BETTIS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1578224481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE BETTIS

Provider Business Mailing Address
First Line	:	2412 WATERFORD
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-7302
Country	:	US
Telephone Number	:	208-670-3639
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 WATERFORD
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82609-7302
Country	:	US
Telephone Number	:	208-670-3639
Fax Number	:

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

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	01/03/2022

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Directions to “ BROOKE BETTIS ” Practice Location

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