Provider Demographics
NPI:1811520885
Name:YETZER-BETTONVILLE, MEGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:YETZER-BETTONVILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 MORSE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8355
Mailing Address - Country:US
Mailing Address - Phone:614-383-8381
Mailing Address - Fax:
Practice Address - Street 1:4625 MORSE RD STE 200
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-8355
Practice Address - Country:US
Practice Address - Phone:614-383-8381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
OHP.07731103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty