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General NPI Number Information
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NPI Number | 1477026672
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Entity Type | Individual
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Provider Name | BETHANY RENEE HENRY LPC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 212 E COLUMBUS AVE STE 1
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2033
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Country | US
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Telephone | 937-599-1411
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Fax |
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Provider Business Mailing Address
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Address Line | 212 E COLUMBUS AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2033
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Country | US
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Telephone | 937-599-1411
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C.1801409-TRNE
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6512644
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License Number State | OH
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