Basic Information
| Provider Information | |||||||||
| NPI: | 1053688473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELAERE | ||||||||
| FirstName: | BETTY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., L.P.C., N.C.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9844 DIXIE HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | FAIR HAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867167600 | ||||||||
| FaxNumber: | 5867167659 | ||||||||
| Practice Location | |||||||||
| Address1: | 9844 DIXIE HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | FAIR HAVEN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867167600 | ||||||||
| FaxNumber: | 5867167659 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2011 | ||||||||
| LastUpdateDate: | 11/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401010954 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.