Provider Demographics
NPI:1932666534
Name:WILLIAMSON, BETHANY F (LPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:F
Last Name:WILLIAMSON
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 1:12600 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-4610
Mailing Address - Country:US
Mailing Address - Phone:414-881-5150
Mailing Address - Fax:
Practice Address - Street 1:2727 N GRANDVIEW BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1671
Practice Address - Country:US
Practice Address - Phone:262-547-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4318226101Y00000X
390200000X
WI7866-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program