Provider Demographics
NPI:1861414757
Name:EHLERT, BETTY JO (PHD)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:JO
Last Name:EHLERT
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 1:10423 153RD CT N
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33478-6819
Mailing Address - Country:US
Mailing Address - Phone:561-745-3149
Mailing Address - Fax:
Practice Address - Street 1:600 SANDTREE DR
Practice Address - Street 2:SUITE 202 D
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33403-1597
Practice Address - Country:US
Practice Address - Phone:561-691-1808
Practice Address - Fax:561-691-1983
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 4147103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73457Medicare ID - Type Unspecified