Provider Demographics
NPI:1427009836
Name:EHLEN, BETH E (LISW-CP)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:E
Last Name:EHLEN
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SUTTER DR.
Mailing Address - Street 2:STE 306
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-8665
Mailing Address - Country:US
Mailing Address - Phone:843-359-0320
Mailing Address - Fax:843-650-0857
Practice Address - Street 1:100 SUTTER DR.
Practice Address - Street 2:STE 306
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-8665
Practice Address - Country:US
Practice Address - Phone:843-359-0320
Practice Address - Fax:843-650-0857
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNX7521Medicare PIN
SCQ337390281Medicare ID - Type Unspecified