Provider Demographics
NPI:1770244279
Name:RADCLIFFE, BETHANY (LPC, NCC, CTP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:RADCLIFFE
Suffix:
Gender:F
Credentials:LPC, NCC, CTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 DURLEY ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1514
Mailing Address - Country:US
Mailing Address - Phone:217-254-8057
Mailing Address - Fax:
Practice Address - Street 1:2014 VANDALIA ST
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4848
Practice Address - Country:US
Practice Address - Phone:618-345-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017739101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional