Provider Demographics
NPI:1487060778
Name:BAXTER, BETTY L (PLPC)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 HA HA TONKA RD
Mailing Address - Street 2:
Mailing Address - City:CAMDENTON
Mailing Address - State:MO
Mailing Address - Zip Code:65020-2112
Mailing Address - Country:US
Mailing Address - Phone:573-434-6806
Mailing Address - Fax:573-873-3569
Practice Address - Street 1:390 CURVY RD
Practice Address - Street 2:
Practice Address - City:CAMDENTON
Practice Address - State:MO
Practice Address - Zip Code:65020-2112
Practice Address - Country:US
Practice Address - Phone:573-434-6806
Practice Address - Fax:573-873-3569
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014020787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health