Provider Demographics
NPI:1801305867
Name:LATIMER, BETHANY T (LPCC-S)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:T
Last Name:LATIMER
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3725
Mailing Address - Country:US
Mailing Address - Phone:330-577-6656
Mailing Address - Fax:844-274-3002
Practice Address - Street 1:223 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2741
Practice Address - Country:US
Practice Address - Phone:330-577-4099
Practice Address - Fax:844-274-3002
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1800629101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272903Medicaid