Healthcare Provider Details

I. General information

NPI: 1568023414
Provider Name (Legal Business Name): GRETCHEN BENTLER MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/14/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MULBERRY ST
SCRANTON PA
18503-1225
US

IV. Provider business mailing address

40 BUBBA LN
CLIFTON TWP PA
18424-7707
US

V. Phone/Fax

Practice location:
  • Phone: 570-955-5479
  • Fax:
Mailing address:
  • Phone: 570-780-4327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013397
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: