Provider Demographics
NPI:1144993049
Name:OTTEN, BETHANY (NCC, LCMHC, MA)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:OTTEN
Suffix:
Gender:F
Credentials:NCC, LCMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3537 ENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-4407
Mailing Address - Country:US
Mailing Address - Phone:980-229-3607
Mailing Address - Fax:
Practice Address - Street 1:1208 THE PLZ
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-5054
Practice Address - Country:US
Practice Address - Phone:704-702-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NC16564101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty