Provider Demographics
NPI:1316436108
Name:OUTLAND, BETSY
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:OUTLAND
Suffix:
Gender:F
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 416
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22824-0416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1085 CANAAN HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:WV
Practice Address - Zip Code:26260-8007
Practice Address - Country:US
Practice Address - Phone:304-851-6643
Practice Address - Fax:304-362-0025
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst