Healthcare Provider Details

I. General information

NPI: 1326407990
Provider Name (Legal Business Name): BETH WHATLEY MS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 US HIGHWAY 231
WETUMPKA AL
36092-5342
US

IV. Provider business mailing address

912 W BRIDGE ST
WETUMPKA AL
36092-2126
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-7830
  • Fax: 334-567-9633
Mailing address:
  • Phone: 334-279-7830
  • Fax: 334-277-8862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3459
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: