Provider Demographics
NPI:1396143194
Name:CONVERSE, BETH
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:CONVERSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34024 W 8 MILE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-5209
Mailing Address - Country:US
Mailing Address - Phone:248-442-2800
Mailing Address - Fax:
Practice Address - Street 1:34024 W 8 MILE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5209
Practice Address - Country:US
Practice Address - Phone:248-442-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000082171100000X
CA7100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist