Healthcare Provider Details

I. General information

NPI: 1821775305
Provider Name (Legal Business Name): GERALD R BETHEL MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HUBER PARK CT STE 200
WELDON SPRING MO
63304-8683
US

IV. Provider business mailing address

500 HUBER PARK CT STE 203
WELDON SPRING MO
63304-8683
US

V. Phone/Fax

Practice location:
  • Phone: 636-336-8382
  • Fax:
Mailing address:
  • Phone: 636-336-8382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: