Healthcare Provider Details

I. General information

NPI: 1780503797
Provider Name (Legal Business Name): BETINA CRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 PINEDA PLAZA WAY STE 209
MELBOURNE FL
32940-7307
US

IV. Provider business mailing address

320 LAGO CIR APT 207
WEST MELBOURNE FL
32904-3218
US

V. Phone/Fax

Practice location:
  • Phone: 321-610-4602
  • Fax:
Mailing address:
  • Phone: 321-610-4602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMT4653
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: