Provider Demographics
NPI:1407296551
Name:PRENTZLER, BETH K (LPC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:K
Last Name:PRENTZLER
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 1:402 S MISSOURI ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:MO
Mailing Address - Zip Code:63552-1337
Mailing Address - Country:US
Mailing Address - Phone:660-346-0432
Mailing Address - Fax:
Practice Address - Street 1:111 N ROLLINS ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:MO
Practice Address - Zip Code:63552-1530
Practice Address - Country:US
Practice Address - Phone:660-346-0432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007012738101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional