Healthcare Provider Details

I. General information

NPI: 1740486109
Provider Name (Legal Business Name): BI BETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 MACARTHUR BLVD 12
OAKLAND CA
94605-5298
US

IV. Provider business mailing address

10700 MACARTHUR BLVD 12
OAKLAND CA
94605-5298
US

V. Phone/Fax

Practice location:
  • Phone: 510-568-2432
  • Fax: 510-568-3912
Mailing address:
  • Phone: 510-568-2432
  • Fax: 510-568-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberN0702242022
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberN0702242022
License Number StateCA

VIII. Authorized Official

Name: MS. EVELYN TRINICE NELSON
Title or Position: PROGRAM COUNSELOR
Credential: RASI
Phone: 510-568-2432