Healthcare Provider Details

I. General information

NPI: 1396947040
Provider Name (Legal Business Name): BETTY MARIE LEMOS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 05/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9541 GROSSMONT SUMMIT DR
LA MESA CA
91941-4105
US

IV. Provider business mailing address

9541 GROSSMONT SUMMIT DR
LA MESA CA
91941-4105
US

V. Phone/Fax

Practice location:
  • Phone: 619-248-3067
  • Fax: 619-741-3150
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number60
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number41012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: