Basic Information
| Provider Information | |||||||||
| NPI: | 1114223484 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEADNELL | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | M.A., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 UNION AVE SE | ||||||||
| Address2: | |||||||||
| City: | MINERVA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446579120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309334778 | ||||||||
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| Practice Location | |||||||||
| Address1: | 919 2ND ST NE | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447041132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304547917 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2011 | ||||||||
| LastUpdateDate: | 02/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | C.1000179 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.