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General NPI Number Information
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NPI Number | 1689447484
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Entity Type | Individual
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Provider Name | BETHANY LEANDRA LOVELY CDCA
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Gender | Female
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Dates
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Enumeration Date | 11/02/2023
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 7529 WARREN SHARON RD
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City | BROOKFIELD
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State | OH
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Zip | 44403-9796
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Country | US
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Telephone | 740-415-1138
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Fax |
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Provider Business Mailing Address
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Address Line | 780 GREGG ST
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City | WASHINGTON COURT HOUSE
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State | OH
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Zip | 43160-1564
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Country | US
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Telephone | 740-313-7513
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Fax | 740-313-7514
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 187746
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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