Provider Demographics
NPI:1578393005
Name:CHIN, BETSY W (MA, LMFT, PCC)
Entity type:Individual
Prefix:
First Name:BETSY
Middle Name:W
Last Name:CHIN
Suffix:
Gender:F
Credentials:MA, LMFT, PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50617
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90050-0617
Mailing Address - Country:US
Mailing Address - Phone:626-739-0508
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 50617
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90050-0617
Practice Address - Country:US
Practice Address - Phone:626-739-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT148334106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist