Provider Demographics
NPI:1184782831
Name:ONTHANK, BETHANY E (LPC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:E
Last Name:ONTHANK
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 1:216 CASS ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2507
Mailing Address - Country:US
Mailing Address - Phone:231-941-1990
Mailing Address - Fax:231-275-7780
Practice Address - Street 1:216 CASS ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2507
Practice Address - Country:US
Practice Address - Phone:231-941-1990
Practice Address - Fax:231-275-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008539101YP2500X
MI80393101YS0200X
MI6801073303104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker