Provider Demographics
NPI:1184335986
Name:BAUER, BETHANY KAY (LLMSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:KAY
Last Name:BAUER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 E MUNGER RD
Mailing Address - Street 2:
Mailing Address - City:MUNGER
Mailing Address - State:MI
Mailing Address - Zip Code:48747-9798
Mailing Address - Country:US
Mailing Address - Phone:989-598-2106
Mailing Address - Fax:
Practice Address - Street 1:33 WHITE TAIL CREEK RD STE 2
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5896
Practice Address - Country:US
Practice Address - Phone:989-220-3808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851109729101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor