Provider Demographics
NPI:1053890889
Name:BETANCOURT, LETICIA R (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:R
Last Name:BETANCOURT
Suffix:
Gender:F
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:TISH
Other - Middle Name:
Other - Last Name:BETANCOURT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, NCC, LPC
Mailing Address - Street 1:15641 CRUISER
Mailing Address - Street 2:B
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418
Mailing Address - Country:US
Mailing Address - Phone:361-739-1005
Mailing Address - Fax:
Practice Address - Street 1:3434 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1720
Practice Address - Country:US
Practice Address - Phone:361-739-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76589101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional