Healthcare Provider Details

I. General information

NPI: 1629363726
Provider Name (Legal Business Name): MARIA D BETANCOURTH M.S., LPCC, PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA D RUIZ LPCC, PPS

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W. SPRAGUE AVE. LUTHERAN COMMUNITY SERVICES (INTERN CLINICIAN)
SPOKANE WA
99201-3816
US

IV. Provider business mailing address

33303 GYPSUM ST
MENIFEE CA
92584-7621
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-8224
  • Fax:
Mailing address:
  • Phone: 509-840-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220071940
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC9668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: