Provider Demographics
NPI:1588432306
Name:JESSIE, BETH MARIE (LPC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:JESSIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 W BELOIT ST
Mailing Address - Street 2:
Mailing Address - City:ORFORDVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53576-9785
Mailing Address - Country:US
Mailing Address - Phone:608-359-2427
Mailing Address - Fax:
Practice Address - Street 1:122 E SPRING ST
Practice Address - Street 2:
Practice Address - City:ORFORDVILLE
Practice Address - State:WI
Practice Address - Zip Code:53576-8770
Practice Address - Country:US
Practice Address - Phone:608-728-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10117-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional