Provider Demographics
NPI:1871311704
Name:BETTS, LATISHA (QMHS)
Entity type:Individual
Prefix:
First Name:LATISHA
Middle Name:
Last Name:BETTS
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2926 23RD ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2429
Mailing Address - Country:US
Mailing Address - Phone:330-802-2728
Mailing Address - Fax:
Practice Address - Street 1:107 TOMMY HENRICH DR NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-5402
Practice Address - Country:US
Practice Address - Phone:330-466-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health