Provider Demographics
NPI:1811461023
Name:GOSNELL, BETH TERESA (ATR-P, LPC-A, NCC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:TERESA
Last Name:GOSNELL
Suffix:
Gender:F
Credentials:ATR-P, LPC-A, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 YACHT CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-9052
Mailing Address - Country:US
Mailing Address - Phone:252-633-6082
Mailing Address - Fax:
Practice Address - Street 1:1425 S GLENBURNIE RD STE 3
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2610
Practice Address - Country:US
Practice Address - Phone:252-514-9888
Practice Address - Fax:252-514-2881
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14877101YM0800X
NC18-183221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health