Healthcare Provider Details

I. General information

NPI: 1275860454
Provider Name (Legal Business Name): BETHANY NICOLE HUTCHISON LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 03/03/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 W ST JOE HWY STE 211
LANSING MI
48917-4850
US

IV. Provider business mailing address

1832 BRIARWOOD DR
LANSING MI
48917-1774
US

V. Phone/Fax

Practice location:
  • Phone: 313-410-6721
  • Fax:
Mailing address:
  • Phone: 313-410-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number57274
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00118456
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401017688
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: