Basic Information
| Provider Information | |||||||||
| NPI: | 1124212626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BETTENCOURT | ||||||||
| FirstName: | TESS | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 567 ELM ST | ||||||||
| Address2: | |||||||||
| City: | DARTMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027482142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082721382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 178 PINE ST | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027202312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086780041 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2007 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7220 | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | M18708 | 01 | MA | BLUE CROSS | OTHER | 1312677 | 05 | MA | MEDICAID |