Provider Demographics
NPI:1588971121
Name:BETEL, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:BETEL
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 1:8336 COLONY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386
Mailing Address - Country:US
Mailing Address - Phone:248-798-6212
Mailing Address - Fax:
Practice Address - Street 1:725 BARCLAY CIRCLE
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-559-8190
Practice Address - Fax:248-702-6704
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014571101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)