Individual
BETHANY R DILLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPCC, CCTP
Contact information
Practice address
12918 63RD AVE N, MAPLE GROVE, MN 55369-6001
(651) 238-1855
Mailing address
12918 63RD AVE N, MAPLE GROVE, MN 55369-6001
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
CC01872
MN
Other
Enumeration date
09/25/2020
Last updated
09/25/2020
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