Provider Demographics
NPI:1932579646
Name:BETHEA, CHERYL (MA, PLCP, M ED, CIT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BETHEA
Suffix:
Gender:F
Credentials:MA, PLCP, M ED, CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 RESERVE DRIVE
Mailing Address - Street 2:APT 411
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3545
Mailing Address - Country:US
Mailing Address - Phone:318-237-1017
Mailing Address - Fax:
Practice Address - Street 1:1325 WRIGHT AVE STE D
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2226
Practice Address - Country:US
Practice Address - Phone:337-514-5181
Practice Address - Fax:337-514-5182
Is Sole Proprietor?:No
Enumeration Date:2015-10-07
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health