Provider Demographics
NPI:1164040713
Name:MERRETT, BETHANY CECELIA (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:CECELIA
Last Name:MERRETT
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30031-1428
Mailing Address - Country:US
Mailing Address - Phone:770-856-1232
Mailing Address - Fax:
Practice Address - Street 1:223 KATHRYN AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5017
Practice Address - Country:US
Practice Address - Phone:770-856-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional