Healthcare Provider Details

I. General information

NPI: 1053688473
Provider Name (Legal Business Name): BETTY J DELAERE M.A., L.P.C., N.C.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9844 DIXIE HIGHWAY
FAIR HAVEN MI
48023
US

IV. Provider business mailing address

9844 DIXIE HIGHWAY
FAIR HAVEN MI
48023
US

V. Phone/Fax

Practice location:
  • Phone: 586-716-7600
  • Fax: 586-716-7659
Mailing address:
  • Phone: 586-716-7600
  • Fax: 586-716-7659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401010954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: