Provider Demographics
NPI:1285859751
Name:BETHEL CENTER FOR PSYCHOTHERAPY
Entity Type:Organization
Organization Name:BETHEL CENTER FOR PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR CLINICAL PSYCHOL
Authorized Official - Prefix:DR
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:630-681-1900
Mailing Address - Street 1:213 W WESLEY ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5135
Mailing Address - Country:US
Mailing Address - Phone:630-681-1900
Mailing Address - Fax:630-462-7669
Practice Address - Street 1:213 W WESLEY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5135
Practice Address - Country:US
Practice Address - Phone:630-681-1900
Practice Address - Fax:630-462-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02221477OtherBLUE CROSS BLUE SHIELD