MEDICARE: BETHANY NICOLE HUTCHISON LPC, CRC

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	225800000X	Recreation Therapist	57274	MI
2	225C00000X	Rehabilitation Counselor	00118456	MI
3	101YP2500X	Professional Counselor	6401017688	MI

General Provider Information

NPI Number	:	1275860454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY NICOLE HUTCHISON LPC, CRC

Provider Business Mailing Address
First Line	:	1832 BRIARWOOD DR
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-1774
Country	:	US
Telephone Number	:	313-410-6721
Fax Number	:

Provider Business Practice Location Address
First Line	:	6105 W ST JOE HWY STE 211
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4850
Country	:	US
Telephone Number	:	313-410-6721
Fax Number	:

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

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	03/03/2023

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