Healthcare Provider Details

I. General information

NPI: 1114714896
Provider Name (Legal Business Name): BETTINA LEA FETTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685A OLD SANTA FE TRL
SANTA FE NM
87505-9347
US

IV. Provider business mailing address

PO BOX 9439
SANTA FE NM
87504-9439
US

V. Phone/Fax

Practice location:
  • Phone: 505-366-9913
  • Fax:
Mailing address:
  • Phone: 505-366-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: