Provider Demographics
NPI:1972699528
Name:ALTMIX, BETH ANN (MHP, BS HUMAN SERVIC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:ALTMIX
Suffix:
Gender:F
Credentials:MHP, BS HUMAN SERVIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 RAY COURT
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:IL
Mailing Address - Zip Code:62338
Mailing Address - Country:US
Mailing Address - Phone:217-223-0413
Mailing Address - Fax:
Practice Address - Street 1:4409 MAINE
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62305-3646
Practice Address - Country:US
Practice Address - Phone:217-223-0423
Practice Address - Fax:217-223-0461
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor