Healthcare Provider Details

I. General information

NPI: 1154470540
Provider Name (Legal Business Name): BETTINA MARIA GARNER EARL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N RANDOLPH ST STE 412
CHAMPAIGN IL
61820-3978
US

IV. Provider business mailing address

206 N RANDOLPH ST STE 412
CHAMPAIGN IL
61820-3978
US

V. Phone/Fax

Practice location:
  • Phone: 219-267-0064
  • Fax: 217-379-4304
Mailing address:
  • Phone: 219-267-0064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: