Basic Information
| Provider Information | |||||||||
| NPI: | 1932579646 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BETHEA | ||||||||
| FirstName: | CHERYL | ||||||||
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| Credential: | MA, PLCP, M. ED, CIT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 116 RESERVE DRIVE | ||||||||
| Address2: | APT 411 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705033545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182371017 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1325 WRIGHT AVE STE D | ||||||||
| Address2: | |||||||||
| City: | CROWLEY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705262226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3375145181 | ||||||||
| FaxNumber: | 3375145182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2015 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.