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NPI Code Detail

MEDICARE: BETTYE PATE HSPP

MEDICARE: BETTYE PATE HSPP
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
1103TC0700XClinical Psychologist20040475AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000209683OTHERINANTHEM PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760454144
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTYE PATE HSPP
Provider Business Mailing Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-337-2438
Provider Business Practice Location Address
First Line : 720 N MARR RD
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-6660
Country : US
Telephone Number : 812-314-3500
Fax Number : 812-378-8367
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 01/23/2015

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Directions to “ BETTYE PATE HSPP” Practice Location

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