Provider Demographics
NPI:1497411482
Name:ZEMICHAEL, BETHEL
Entity Type:Individual
Prefix:
First Name:BETHEL
Middle Name:
Last Name:ZEMICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 N MERCIER AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3119
Mailing Address - Country:US
Mailing Address - Phone:573-680-2647
Mailing Address - Fax:
Practice Address - Street 1:5425 N MERCIER AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64118-3119
Practice Address - Country:US
Practice Address - Phone:573-680-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3895524778103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool