Provider Demographics
NPI:1427374115
Name:MATENAER, BETH (MA, LPC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:MATENAER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 ROOKWOOD PL
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8184
Mailing Address - Country:US
Mailing Address - Phone:843-696-6127
Mailing Address - Fax:843-278-7769
Practice Address - Street 1:1060 CLIFFWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3687
Practice Address - Country:US
Practice Address - Phone:843-696-6127
Practice Address - Fax:843-278-7769
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5136101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor