Provider Demographics
NPI:1578812442
Name:BETHEL, PAULETTE M (MA LMFT, LPC)
Entity Type:Individual
Prefix:DR
First Name:PAULETTE
Middle Name:M
Last Name:BETHEL
Suffix:
Gender:F
Credentials:MA LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WINSTON DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5787
Mailing Address - Country:US
Mailing Address - Phone:770-674-2770
Mailing Address - Fax:
Practice Address - Street 1:285 S PERRY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4840
Practice Address - Country:US
Practice Address - Phone:770-733-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14673101YP2500X
TX4951106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional