Basic Information
| Provider Information | |||||||||
| NPI: | 1316389398 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMERY | ||||||||
| FirstName: | BETH | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9385 N BLAIR RD | ||||||||
| Address2: | |||||||||
| City: | BRECKENRIDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486159749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893306661 | ||||||||
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| Practice Location | |||||||||
| Address1: | 301 S CRAPO ST | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488582941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897725938 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2013 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1888386 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 6801067743 | MI | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.