MEDICARE: FAMILY AID, INC.

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	103TC0700X	Clinical Psychologist	1857	AZ

General Provider Information

NPI Number	:	1659495687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY AID, INC.

Provider Business Mailing Address
First Line	:	5348 VEGAS DR
Second Line	:	#67
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5348 VEGAS DR
Second Line	:	#67
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2347
Country	:	US
Telephone Number	:	413-653-6228
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. GARY C. BETTIS
Credential	:	PH.D.
Telephone Number	:	413-653-6228

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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