Healthcare Provider Details

I. General information

NPI: 1609673847
Provider Name (Legal Business Name): BETHANY ALLEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 PROFESSIONAL PKWY
RIDGELAND MS
39157-4113
US

IV. Provider business mailing address

6 PROFESSIONAL PKWY
RIDGELAND MS
39157-4113
US

V. Phone/Fax

Practice location:
  • Phone: 601-603-2335
  • Fax:
Mailing address:
  • Phone: 601-603-2335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3231
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: