Provider Demographics
NPI:1316236425
Name:POWERS BEITLER, PENNY (LMFT)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:
Last Name:POWERS BEITLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 HAPP RD
Mailing Address - Street 2:205
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3455
Mailing Address - Country:US
Mailing Address - Phone:847-256-0200
Mailing Address - Fax:
Practice Address - Street 1:310 HAPP RD
Practice Address - Street 2:205
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3455
Practice Address - Country:US
Practice Address - Phone:847-256-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist