Provider Demographics
NPI:1063874394
Name:RANGE, BETHANY JOY (LLMSW)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:JOY
Last Name:RANGE
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 1:9315 TELEGRAPH ROAD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239
Mailing Address - Country:US
Mailing Address - Phone:734-516-0422
Mailing Address - Fax:
Practice Address - Street 1:9315 TELEGRAPH ROAD
Practice Address - Street 2:
Practice Address - City:REDORD
Practice Address - State:MI
Practice Address - Zip Code:48239
Practice Address - Country:US
Practice Address - Phone:734-516-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010954451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical