Provider Demographics
NPI:1417263419
Name:FETZER, BETHANNE (MED, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BETHANNE
Middle Name:
Last Name:FETZER
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:MS
Other - First Name:BETHANNE
Other - Middle Name:FRENCH
Other - Last Name:WOODHOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, LPC
Mailing Address - Street 1:1107 WEST COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801
Mailing Address - Country:US
Mailing Address - Phone:814-325-0280
Mailing Address - Fax:814-826-2241
Practice Address - Street 1:1107 WEST COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-325-0280
Practice Address - Fax:814-826-2241
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2021-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
PAPC005818101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional