MEDICARE: MS. RHONDA LEIGH BETHMANN LPC

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	101YP2500X	Professional Counselor	2008024134	MO

General Provider Information

NPI Number	:	1740424845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RHONDA LEIGH BETHMANN LPC

Provider Business Mailing Address
First Line	:	566 1ST CAPITOL DR
Second Line	:	SUITE 203
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2726
Country	:	US
Telephone Number	:	636-578-9678
Fax Number	:	636-947-7365

Provider Business Practice Location Address
First Line	:	566 1ST CAPITOL DR
Second Line	:	SUITE 203
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-2726
Country	:	US
Telephone Number	:	636-578-9678
Fax Number	:	636-947-7365

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

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	01/03/2011

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