Provider Demographics
NPI:1215152533
Name:WOLFE, BETH A (PHD, LMHC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:WOLFE
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:A
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:2194 HIGHWAY A1A
Mailing Address - Street 2:SUITE 203
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4930
Mailing Address - Country:US
Mailing Address - Phone:321-821-0762
Mailing Address - Fax:
Practice Address - Street 1:2194 HIGHWAY A1A
Practice Address - Street 2:SUITE 203
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4930
Practice Address - Country:US
Practice Address - Phone:321-821-0762
Practice Address - Fax:321-773-5479
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12047101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL601702Medicaid