Provider Demographics
NPI:1619291523
Name:MCELYEA, BETHANY BRECKENRIDGE (LPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:BRECKENRIDGE
Last Name:MCELYEA
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 1:102 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39817-3614
Mailing Address - Country:US
Mailing Address - Phone:229-416-4737
Mailing Address - Fax:229-416-4738
Practice Address - Street 1:102 BROAD STREET
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-3614
Practice Address - Country:US
Practice Address - Phone:229-416-4737
Practice Address - Fax:229-416-4738
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002348101YP2500X
GALPC006633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003194071AMedicaid