Provider Demographics
NPI:1235829037
Name:GROTH, BEVERLY D (LPC,SCL,NCC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:D
Last Name:GROTH
Suffix:
Gender:F
Credentials:LPC,SCL,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 PINECLIFF CT
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1794
Mailing Address - Country:US
Mailing Address - Phone:248-884-1728
Mailing Address - Fax:
Practice Address - Street 1:351 PINECLIFF CT
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1794
Practice Address - Country:US
Practice Address - Phone:248-301-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008473101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional