Healthcare Provider Details

I. General information

NPI: 1497464986
Provider Name (Legal Business Name): PETRA BETTERTON LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 SE ARBOR DR
TOPEKA KS
66605-2128
US

IV. Provider business mailing address

3030 SE ARBOR DR
TOPEKA KS
66605-2128
US

V. Phone/Fax

Practice location:
  • Phone: 808-551-7761
  • Fax:
Mailing address:
  • Phone: 808-551-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-011259
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-03425
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: