Healthcare Provider Details

I. General information

NPI: 1831067586
Provider Name (Legal Business Name): STACIE MICHELE BETANCOURT PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 SITES WAY
BIG BEAR CITY CA
92314-9178
US

IV. Provider business mailing address

377 SITES WAY
BIG BEAR CITY CA
92314-9178
US

V. Phone/Fax

Practice location:
  • Phone: 909-733-2346
  • Fax:
Mailing address:
  • Phone: 909-733-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberAAB2C399BB
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: