Mrs Betsy Brooke Henninger, LPC | |
326 E Main St, Grantsville, UT 84029-9691 | |
(435) 840-4209 | |
Not Available |
Full Name | Mrs Betsy Brooke Henninger |
---|---|
Gender | Female |
Speciality | Counselor - Professional |
Location | 326 E Main St, Grantsville, Utah |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1811957921 | NPI | - | NPPES |
20-4382140 | Other | UT | FEDERAL TAX ID# |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 5084755-6004 (Utah) | Primary |
Entity Name | Brightside Health Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1073072658 PECOS PAC ID: 9234525098 Enrollment ID: O20230627000845 |
Mailing Address | Practice Location Address |
---|---|
Mrs Betsy Brooke Henninger, LPC Po Box 900245, Sandy, UT 84090-0245 Ph: (801) 634-8727 | Mrs Betsy Brooke Henninger, LPC 326 E Main St, Grantsville, UT 84029-9691 Ph: (435) 840-4209 |
Ashley Carrubba, ACMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 822 E Main St Ste G, Grantsville, UT 84029 Phone: 435-850-0034 | |
Wendy Hunt, CSW Counselor Medicare: Not Enrolled in Medicare Practice Location: 505 Nygreen St, Grantsville, UT 84029 Phone: 801-450-8813 | |
Regina C Tippets, CMHC Counselor Medicare: Not Enrolled in Medicare Practice Location: 505 Nygreen St, Grantsville, UT 84029 Phone: 801-455-0361 | |
Sidney Pearson, Counselor Medicare: Not Enrolled in Medicare Practice Location: 822 E Main St Ste G, Grantsville, UT 84029 Phone: 435-850-0034 |