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General NPI Number Information
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NPI Number | 1770244279
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Entity Type | Individual
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Provider Name | BETHANY RADCLIFFE LCPC, NCC, CCTP
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Gender | Female
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Dates
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Enumeration Date | 01/06/2022
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 2014 VANDALIA ST
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City | COLLINSVILLE
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State | IL
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Zip | 62234-4848
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Country | US
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Telephone | 618-345-9536
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 RIDGE AVE
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City | GREENVILLE
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State | IL
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Zip | 62246-2558
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Country | US
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Telephone | 217-254-8057
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.017739
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License Number State | IL
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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 | 180.016122
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License Number State | IL
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