Provider Demographics
NPI:1487873659
Name:BETHESDA COUNSELING SEVICES LLC
Entity type:Organization
Organization Name:BETHESDA COUNSELING SEVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MAR LPC
Authorized Official - Phone:269-375-2833
Mailing Address - Street 1:10040 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9426
Mailing Address - Country:US
Mailing Address - Phone:269-375-2833
Mailing Address - Fax:269-375-2838
Practice Address - Street 1:4200 W MICHIGAN AVE STE 243 # 8
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-5892
Practice Address - Country:US
Practice Address - Phone:269-375-2833
Practice Address - Fax:269-375-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004079101YP2500X, 106H00000X
MI6301001601103TC0700X
MI6301007397103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty