Provider Demographics
NPI:1417360215
Name:BENTLEY, RACHEL (LPC)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:BRIDGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5966 HARPER RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842-8618
Mailing Address - Country:US
Mailing Address - Phone:810-513-4976
Mailing Address - Fax:
Practice Address - Street 1:2970 E LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7415
Practice Address - Country:US
Practice Address - Phone:517-230-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2024-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MI6401014192101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty