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General NPI Number Information
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NPI Number | 1033150834
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Entity Type | Individual
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Provider Name | LAURA LYNN BETTOR PHD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 07/26/2010
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Provider Practice Location Address
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Address Line | 1310 S 1ST ST
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City | AUSTIN
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State | TX
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Zip | 78704-3056
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Country | US
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Telephone | 512-971-7819
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Fax |
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Provider Business Mailing Address
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Address Line | 5720 REPUBLIC OF TEXAS BLVD
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City | AUSTIN
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State | TX
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Zip | 78735-6512
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Country | US
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Telephone | 512-971-7819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2-5215
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License Number State | TX
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