Healthcare Provider Details

I. General information

NPI: 1811520885
Provider Name (Legal Business Name): MEGAN YETZER-BETTONVILLE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 MORSE RD STE 200
GAHANNA OH
43230-8355
US

IV. Provider business mailing address

4625 MORSE RD STE 200
GAHANNA OH
43230-8355
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-8381
  • Fax:
Mailing address:
  • Phone: 614-383-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberP.07731
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: