Provider Demographics
NPI:1144549601
Name:BETTIS-WEBER, KAYLA M (LCSW)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:BETTIS-WEBER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E MONUMENT ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1004
Mailing Address - Country:US
Mailing Address - Phone:719-447-0370
Mailing Address - Fax:719-447-0371
Practice Address - Street 1:212 E MONUMENT ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1004
Practice Address - Country:US
Practice Address - Phone:719-447-0370
Practice Address - Fax:719-447-0371
Is Sole Proprietor?:No
Enumeration Date:2010-05-24
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical