Provider Demographics
NPI:1255646014
Name:BETH BUDESHEIM, LLC
Entity type:Organization
Organization Name:BETH BUDESHEIM, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUDESHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:717-608-7623
Mailing Address - Street 1:139 S MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-7358
Mailing Address - Country:US
Mailing Address - Phone:717-608-7623
Mailing Address - Fax:
Practice Address - Street 1:139 S MEADOW LN
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-7358
Practice Address - Country:US
Practice Address - Phone:717-608-7623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty