Healthcare Provider Details

I. General information

NPI: 1497260350
Provider Name (Legal Business Name): BETHANY LYNN REYANT LADC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10249 555TH ST
WEST CONCORD MN
55985-4043
US

IV. Provider business mailing address

10249 555TH ST
WEST CONCORD MN
55985-4043
US

V. Phone/Fax

Practice location:
  • Phone: 507-390-2215
  • Fax:
Mailing address:
  • Phone: 507-390-2215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number304364
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number101771
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101771
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number03069
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: