Provider Demographics
NPI:1174067649
Name:BETTERS, PATRICK W (BCBA)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:W
Last Name:BETTERS
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11665 AVENA PL
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2421
Mailing Address - Country:US
Mailing Address - Phone:760-349-4200
Mailing Address - Fax:
Practice Address - Street 1:11665 AVENA PL
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2421
Practice Address - Country:US
Practice Address - Phone:760-349-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-16-24220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst