Provider Demographics
NPI:1336035138
Name:GOSNELL, BETHANY (LPC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CAMAK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1407
Mailing Address - Country:US
Mailing Address - Phone:770-843-5042
Mailing Address - Fax:
Practice Address - Street 1:2775 CRUSE RD STE 2601
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-7148
Practice Address - Country:US
Practice Address - Phone:770-925-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC013198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health