Individual
STACY E BETTELON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC
Contact information
Practice address
734 W POLK ST, PHOENIX, AZ 85007-2539
(602) 848-3323
Mailing address
PO BOX 401, GILSUM, NH 03448-0401
(623) 332-0066
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LAC-19691
AZ
Other
Enumeration date
07/25/2024
Last updated
07/25/2024
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