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General NPI Number Information
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NPI Number | 1902442379
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Entity Type | Individual
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Provider Name | BETHANY JOY HANKS LLMSW
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Gender | Female
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 11/20/2019
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Provider Practice Location Address
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Address Line | 11555 W GRAND RIVER AVE
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City | LOWELL
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State | MI
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Zip | 49331-8464
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Country | US
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Telephone | 616-228-1286
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Fax |
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Provider Business Mailing Address
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Address Line | 349 CARLTON AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49506-1609
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Country | US
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Telephone | 586-662-1989
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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 | 6801106082
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License Number State | MI
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