Provider Demographics
NPI:1639650625
Name:FOERG, BETHANY (LMFTA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:FOERG
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 S BUSINESS 31
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-7312
Mailing Address - Country:US
Mailing Address - Phone:765-472-2722
Mailing Address - Fax:
Practice Address - Street 1:2484 S BUSINESS 31 STE C
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-7325
Practice Address - Country:US
Practice Address - Phone:765-472-2722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002072A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist