Individual
BETTYE PATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HSPP
Contact information
Practice address
720 N MARR RD, COLUMBUS, IN 47201-6660
(812) 314-3500
(812) 378-8367
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
(812) 337-2438
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040475A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209683
ANTHEM PIN
IN
05
—
200003790A
—
IN
Enumeration date
02/01/2006
Last updated
01/23/2015
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