Provider Demographics
NPI:1275860454
Name:HUTCHISON, BETHANY NICOLE (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:NICOLE
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1832 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-1774
Mailing Address - Country:US
Mailing Address - Phone:313-410-6721
Mailing Address - Fax:
Practice Address - Street 1:6105 W ST JOE HWY STE 211
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4850
Practice Address - Country:US
Practice Address - Phone:313-410-6721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI57274225800000X
MI00118456225C00000X
MI6401017688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor