MEDICARE: MS. BETTE CROMER ALTHOF M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C4110	OH

General Provider Information

NPI Number	:	1013132133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETTE CROMER ALTHOF M.A.

Provider Business Mailing Address
First Line	:	1456 JACKSON PIKE
Second Line	:
City	:	GALLIPOLIS
State	:	OH
Zip	:	45631-2602
Country	:	US
Telephone Number	:	740-446-8289
Fax Number	:	740-446-2926

Provider Business Practice Location Address
First Line	:	1456 JACKSON PIKE
Second Line	:
City	:	GALLIPOLIS
State	:	OH
Zip	:	45631-2602
Country	:	US
Telephone Number	:	740-446-8289
Fax Number	:	740-446-2926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	07/08/2007

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