Individual
DR. CHARLES WILLIAM BETHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1050 SILVER DR, TRAVERSE CITY, MI 49684-5749
(231) 947-2255
(231) 947-5982
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000
(616) 281-6459
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401001279
MI
1041C0700X
Clinical Social Worker
6801010401
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6401001279
PROFESSIONAL COUNSELOR LI
MI
01
—
6801010401
MASTER SOCIAL WORKER LICE
MI
Enumeration date
11/30/2006
Last updated
04/22/2008
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