Provider Demographics
NPI:1043640501
Name:BETSCHOWA, DONNA (CAC 111)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:
Last Name:BETSCHOWA
Suffix:
Gender:F
Credentials:CAC 111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 SPAULDING LN LOT 15
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1858
Mailing Address - Country:US
Mailing Address - Phone:970-484-1870
Mailing Address - Fax:
Practice Address - Street 1:301 SPAULDING LN LOT 15
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1858
Practice Address - Country:US
Practice Address - Phone:970-484-1870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7223101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)