Active NPI
Stacy E Bettelon, LAC
- Counselor
- Phoenix, AZ
National Provider Identifier
1295563658
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- LAC-19691
- Practice address
- 734 W Polk St
Phoenix, AZ 85007-2539 - Phone
- (602) 848-3323
- NPI assigned
- Jul 25, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | LAC-19691 | AZ | Primary |
Addresses
Primary practice location
734 W Polk St
Phoenix, AZ 85007-2539
Mailing address
PO Box 401
Gilsum, NH 03448-0401
Phone (623) 332-0066
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAC-19691 | AZ | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1721865600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721865600000",
"number": "1295563658",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 401",
"city": "GILSUM",
"state": "NH",
"postal_code": "034480401",
"telephone_number": "623-332-0066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "734 W POLK ST",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850072539",
"telephone_number": "602-848-3323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETTELON",
"first_name": "STACY",
"middle_name": "E",
"credential": "LAC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-07-25",
"last_updated": "2024-07-25",
"certification_date": "2024-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AZ",
"license": "LAC-19691",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.