Basic Information
| Provider Information | |||||||||
| NPI: | 1679299796 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BETTS | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15822 GARRISON CIR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787173005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127912785 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2901 CABALLO RANCH BLVD STE 6A | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786414637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127632186 | ||||||||
| FaxNumber: | 5127276364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2022 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 60344 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.