MEDICARE: BETTY ANN HAVEY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT 20096	CA

General Provider Information

NPI Number	:	1194700385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY ANN HAVEY LMFT

Provider Business Mailing Address
First Line	:	2520 EAST VINA DEL MAR BLVD
Second Line	:
City	:	ST PETERSBURG BEACH
State	:	FL
Zip	:	33707
Country	:	US
Telephone Number	:	850-524-4090
Fax Number	:

Provider Business Practice Location Address
First Line	:	2520 EAST VINA DEL MAR BLVD
Second Line	:
City	:	ST PETERSBURG BEACH
State	:	FL
Zip	:	33707
Country	:	US
Telephone Number	:	850-524-4090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	08/21/2008

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