Provider Demographics
NPI:1750447645
Name:BOATMAN, BETH M (LPC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:M
Last Name:BOATMAN
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 1:1435 OGLETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2135
Mailing Address - Country:US
Mailing Address - Phone:706-549-7755
Mailing Address - Fax:706-549-0428
Practice Address - Street 1:1435 OGLETHORPE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2135
Practice Address - Country:US
Practice Address - Phone:706-549-7755
Practice Address - Fax:706-549-0428
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA237098832OtherTAX ID NUMBER