Provider Demographics
NPI:1063796993
Name:LOEB, BETHEA ELIZABETH (LMHC)
Entity type:Individual
Prefix:
First Name:BETHEA
Middle Name:ELIZABETH
Last Name:LOEB
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:BETHEA
Other - Middle Name:ELIZABETH
Other - Last Name:WOODSMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3136 BROCKWAY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-5103
Mailing Address - Country:US
Mailing Address - Phone:319-232-2086
Mailing Address - Fax:319-232-6846
Practice Address - Street 1:3136 BROCKWAY RD
Practice Address - Street 2:SUITE B
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5103
Practice Address - Country:US
Practice Address - Phone:319-232-2086
Practice Address - Fax:319-232-6846
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health