Provider Demographics
NPI:1114714896
Name:FETTER, BETTINA LEA
Entity type:Individual
Prefix:
First Name:BETTINA
Middle Name:LEA
Last Name:FETTER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9439
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-9439
Mailing Address - Country:US
Mailing Address - Phone:505-366-9913
Mailing Address - Fax:
Practice Address - Street 1:7685A OLD SANTA FE TRL
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-9347
Practice Address - Country:US
Practice Address - Phone:505-366-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health