Provider Demographics
NPI:1477026672
Name:HENRY, BETHANY RENEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:RENEE
Last Name:HENRY
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 1:212 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2033
Mailing Address - Country:US
Mailing Address - Phone:937-599-1411
Mailing Address - Fax:
Practice Address - Street 1:212 E COLUMBUS AVE STE 1
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2033
Practice Address - Country:US
Practice Address - Phone:937-599-1411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801409-TRNE101Y00000X
OH6512644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor