Provider Demographics
NPI:1720631807
Name:BETHEA, MARTHA ROSE HALL (MA LPC)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ROSE HALL
Last Name:BETHEA
Suffix:
Gender:
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N CIRCLE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1161
Mailing Address - Country:US
Mailing Address - Phone:719-644-6950
Mailing Address - Fax:
Practice Address - Street 1:2500 N CIRCLE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1161
Practice Address - Country:US
Practice Address - Phone:719-644-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020883101YP2500X
CO0019458101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional