Healthcare Provider Details

I. General information

NPI: 1043401755
Provider Name (Legal Business Name): CARLA LOUISE BETTROSS PCC-S, ATR-BC, PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SHERIDAN RD
POLAND OH
44514-1680
US

IV. Provider business mailing address

33 SHERIDAN RD
POLAND OH
44514-1680
US

V. Phone/Fax

Practice location:
  • Phone: 330-605-3873
  • Fax:
Mailing address:
  • Phone: 330-605-3873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004227
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0004279
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: