Provider Demographics
NPI:1447886551
Name:BETTIS, CHRISTEN RENEE (LMT, IBCLC)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:RENEE
Last Name:BETTIS
Suffix:
Gender:F
Credentials:LMT, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 N LAMAR BLVD APT 921
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-1718
Mailing Address - Country:US
Mailing Address - Phone:512-955-2795
Mailing Address - Fax:
Practice Address - Street 1:12007 N LAMAR BLVD APT 921
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1718
Practice Address - Country:US
Practice Address - Phone:512-955-2795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT115676225700000X
TXL-136295174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist