Provider Demographics
NPI:1699929968
Name:BEUTLER, GRETTA M (M COUN, LPC)
Entity type:Individual
Prefix:MRS
First Name:GRETTA
Middle Name:M
Last Name:BEUTLER
Suffix:
Gender:F
Credentials:M COUN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 W JUDICIAL ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2715
Mailing Address - Country:US
Mailing Address - Phone:208-782-2060
Mailing Address - Fax:
Practice Address - Street 1:90 W JUDICIAL ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2715
Practice Address - Country:US
Practice Address - Phone:208-782-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4088101YP2500X
ID101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1538352828OtherNPI