Bethel, Marisa Renee
Bethel, Marisa Renee is an individual health care provider with primary practice located at 111 W Washington St , East Peoria IL 61611-2532. She recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as her primary health care specialty. Bethel, Marisa Renee can be contacted via phone (309) 694-6462.Contact Information
Primary practice address
111 W Washington St
East Peoria IL 61611-2532
Phone: (309) 694-6462
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X |
Profile Details
| NPI number | 1376214460 |
|---|---|
| LBN Legal business name | Bethel, Marisa Renee |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 28th, 2021 |
| Last updated | Sep 28th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376214460 | NPPES |
| Other | 101YA0400X | TAXONOMY |
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