Provider Demographics
NPI:1720388150
Name:BEDELL, TINA MARIE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:MARIE
Last Name:BEDELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRADLEY PARK CT STE 1H
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3634
Mailing Address - Country:US
Mailing Address - Phone:706-327-1222
Mailing Address - Fax:706-327-1444
Practice Address - Street 1:4 BRADLEY PARK CT STE 1H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3634
Practice Address - Country:US
Practice Address - Phone:706-327-1222
Practice Address - Fax:706-327-1444
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist