Provider Demographics
NPI:1265007785
Name:MANGAN, BETHANY (LMSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MANGAN
Suffix:
Gender:
Credentials:LMSW
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:COON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLMSW
Mailing Address - Street 1:8149 GREEN VALLEY DR.
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504
Mailing Address - Country:US
Mailing Address - Phone:616-987-0883
Mailing Address - Fax:
Practice Address - Street 1:11650 DOWNES ST NE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9489
Practice Address - Country:US
Practice Address - Phone:616-897-7842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801118189104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker