Healthcare Provider Details

I. General information

NPI: 1902955065
Provider Name (Legal Business Name): BETSY L GILPIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 12/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 E MISSOURI AVE SUITE M
PHOENIX AZ
85014-2788
US

IV. Provider business mailing address

1133 E MISSOURI AVE SUITE M
PHOENIX AZ
85014-2788
US

V. Phone/Fax

Practice location:
  • Phone: 602-234-0870
  • Fax: 602-274-3422
Mailing address:
  • Phone: 602-234-0870
  • Fax: 602-274-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPHD975
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: