Healthcare Provider Details

I. General information

NPI: 1841282084
Provider Name (Legal Business Name): BETSY MILLS LPC, SAP, CEAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETSY KLAUS MHC

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 PIERCE AVE
MACON GA
31204-2821
US

IV. Provider business mailing address

179 PIERCE AVE
MACON GA
31204-2821
US

V. Phone/Fax

Practice location:
  • Phone: 478-742-1464
  • Fax: 478-742-1883
Mailing address:
  • Phone: 478-742-1464
  • Fax: 478-742-1883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39001504A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1819
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: