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NPI Code Detail

MEDICARE: CARRIE JEAN BETTENHAUSEN

MEDICARE: CARRIE JEAN BETTENHAUSEN
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
1101YM0800XMental Health Counselor
2101Y00000XCounselor

General Provider Information

NPI Number : 1598894248
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE JEAN BETTENHAUSEN
Provider Business Mailing Address
First Line : 3587 HEATHROW WAY
Second Line :
City : MEDFORD
State : OR
Zip : 97504-4004
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1592 MONROE ST
Second Line :
City : NORTH BEND
State : OR
Zip : 97459-3657
Country : US
Telephone Number : 541-260-1003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 03/24/2017

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Directions to “ CARRIE JEAN BETTENHAUSEN ” Practice Location

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