Basic Information
| Provider Information | |||||||||
| NPI: | 1801900915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TETU | ||||||||
| FirstName: | BETTY | ||||||||
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| Credential: | CAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1503 CREED ST | ||||||||
| Address2: | |||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 713605139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184510481 | ||||||||
| FaxNumber: | 3184875703 | ||||||||
| Practice Location | |||||||||
| Address1: | UNIT 6 MEADOW LANE | ||||||||
| Address2: | CLSH RED RIVER TREATMENT CENTER | ||||||||
| City: | PINEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184846400 | ||||||||
| FaxNumber: | 3184875703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 101YA0400X | CAC 1007 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.