Individual
DR. LAURA LYNN BETTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1310 S 1ST ST, AUSTIN, TX 78704-3056
(512) 971-7819
Mailing address
5720 REPUBLIC OF TEXAS BLVD, AUSTIN, TX 78735-6512
(512) 971-7819
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2-5215
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040767801
—
TX
01
—
680014218
RAILROAD MEDICARE
TX
01
—
86338A
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/10/2006
Last updated
07/26/2010
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