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General NPI Number Information
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NPI Number | 1710171731
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Entity Type | Individual
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Provider Name | ISSIS M. BETTS-JIMENEZ MA
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Gender | Female
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Dates
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Enumeration Date | 09/03/2007
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | VA SOMERSET CLINIC 163 TOWER CIR
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City | SOMERSET
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State | KY
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Zip | 42503
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Country | US
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Telephone | 606-676-0786
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Fax |
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Provider Business Mailing Address
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Address Line | VA SOMERSET CLINIC 163 TOWER CIR
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City | SOMERSET
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State | KY
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Zip | 42503
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Country | US
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Telephone | 606-676-0786
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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 | 9779-PY-PR
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License Number State | MA
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