Crystal Marie Bettenhausen-Bubulka, HI LCSW 4606

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW100639 Issued in CA

Practice address

1050 Kettner Blvd Ste D
San Diego, CA 92101-3339

Phone

(808) 319-7896

NPI assigned

Feb 9, 2021

Last updated

Dec 31, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Crystal Marie Bettenhausen Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Strength in Service

  • Mental Health Counselor
  • Coronado, CA
  • NPI 1689405508
  NPD Authorized official
• Strength in Service

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Coronado, CA
  • NPI 1699510958
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1612828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640908800000",
    "number": "1790377067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "941 ORANGE AVE # 536",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921182609",
            "telephone_number": "808-319-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 KETTNER BLVD STE D",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013339",
            "telephone_number": "808-319-7896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "74 Kihapai St",
            "address_purpose": "LOCATION",
            "city": "Kailua",
            "state": "HI",
            "postal_code": "967342612",
            "country_code": "US",
            "telephone_number": "808-319-7896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BETTENHAUSEN-BUBULKA",
        "first_name": "CRYSTAL",
        "middle_name": "MARIE",
        "credential": "HI LCSW 4606",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-09",
        "last_updated": "2021-12-31",
        "certification_date": "2021-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "4606",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW100639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CRYSTAL",
            "last_name": "BETTENHAUSEN",
            "middle_name": "MARIE",
            "credential": "HI LCSW 4606",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.