Individual
MRS. BETTIE KATHLEEN KOONTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAS-I
Contact information
Practice address
17727 E CYPRESS ST, COVINA, CA 91722-2634
(626) 967-2677
Mailing address
17727 E CYPRESS ST, COVINA, CA 91722-2634
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4986-I
CA
Other
Enumeration date
07/15/2015
Last updated
12/13/2016
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