Provider Demographics
NPI:1902955065
Name:GILPIN, BETSY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:L
Last Name:GILPIN
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 1:1133 E MISSOURI AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2788
Mailing Address - Country:US
Mailing Address - Phone:602-234-0870
Mailing Address - Fax:602-274-3422
Practice Address - Street 1:1133 E MISSOURI AVE
Practice Address - Street 2:SUITE M
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2788
Practice Address - Country:US
Practice Address - Phone:602-234-0870
Practice Address - Fax:602-274-3422
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPHD975103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ043215OtherMHN #
AZAZ0609390OtherBCBS #
AZPHD975Medicare UPIN