Provider Demographics
NPI:1013515402
Name:ADAMS, BETHANY JOY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:JOY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:BETHANY
Other - Middle Name:JOY
Other - Last Name:SACKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NONE
Mailing Address - Street 1:15829 LOCKE LN
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9403
Mailing Address - Country:US
Mailing Address - Phone:269-760-2083
Mailing Address - Fax:
Practice Address - Street 1:2700 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-5500
Practice Address - Country:US
Practice Address - Phone:269-760-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010953691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical