Provider Demographics
NPI:1790748986
Name:MIKESELL, BETH DENA (MS)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:DENA
Last Name:MIKESELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 GREGORY LN
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-3386
Mailing Address - Country:US
Mailing Address - Phone:925-825-2384
Mailing Address - Fax:925-676-6907
Practice Address - Street 1:81 GREGORY LN
Practice Address - Street 2:SUITE 305
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-3386
Practice Address - Country:US
Practice Address - Phone:925-825-2384
Practice Address - Fax:925-676-6907
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT31047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist