Healthcare Provider Details

I. General information

NPI: 1427650159
Provider Name (Legal Business Name): BETSY GHOLSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SCARBOUROUGH
CANYON LAKE TX
78133-4529
US

IV. Provider business mailing address

5447 HAWK EYE DR
BULVERDE TX
78163-2255
US

V. Phone/Fax

Practice location:
  • Phone: 830-964-4390
  • Fax:
Mailing address:
  • Phone: 210-789-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number80997
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: