Basic Information
| Provider Information | |||||||||
| NPI: | 1154583342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ATWELL | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | JOY | ||||||||
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| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7313 VILLAGE PARK DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483461994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486008222 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6548 TOWN CENTER DR STE D | ||||||||
| Address2: | |||||||||
| City: | CLARKSTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486008222 | ||||||||
| FaxNumber: | 2486053525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2008 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101Y00000X | 6401010070 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.