Organization
COLLEEN BETHEL, MSW, LICSW, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN PATRICIA HAVLIN BETHEL LICSW (OWNER)
(612) 562-7988
Entity
Organization
Contact information
Practice address
1904 44TH AVE N, MINNEAPOLIS, MN 55412-1210
(612) 529-5146
Mailing address
1904 44TH AVE N, MINNEAPOLIS, MN 55412-1210
(612) 529-5146
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598064016
NPI 1
MN
Enumeration date
03/23/2021
Last updated
05/09/2022
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