Bethany Rose Ann Petronella, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

LPC009119 Issued in GA

Practice address

1303 Hightower TRL
230
Sandy Springs, GA 30350-2962

Phone

(678) 395-7922

Fax

(678) 954-6589

NPI assigned

Feb 2, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Bethany Rose Ann Kinzel Professional name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• devoted network organization-84bf27aa-506a-49c4-8818-702cf5e8efb3
• FL HMO
• devoted network organization-d5084670-562f-408b-b100-22a1a4ef4d82
• TN PPO
• devoted network organization-14bfd35d-d818-4696-813b-340339e464ef
• FL HMO C-SNP
• AL HMO D-SNP
• FL HMO D-SNP
• AL HMO
• devoted network organization-25ba88d3-d0a6-4213-84f1-eef6f2b59f68
• TN PPO C-SNP
• devoted network organization-0f7f8d4f-1035-4992-8c02-dc86d12e700e

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  GA, Professional

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485993600000",
    "number": "1003354705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 HIGHTOWER TRL",
            "address_2": "230",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303502962",
            "telephone_number": "678-395-7922",
            "fax_number": "678-954-6589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1303 HIGHTOWER TRL",
            "address_2": "230",
            "city": "SANDY SPRINGS",
            "state": "GA",
            "postal_code": "303502962",
            "telephone_number": "678-395-7922",
            "fax_number": "678-954-6589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONELLA",
        "first_name": "BETHANY ROSE",
        "middle_name": "ANN",
        "credential": "LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-02-02",
        "last_updated": "2017-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "GA",
            "license": "LPC009119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BETHANY ROSE",
            "last_name": "KINZEL",
            "middle_name": "ANN",
            "credential": "LPC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Khaleah Perry
• Amelia Persaud, OTR/L, IBCLC
• Mark Persaud, DDS
• Personalized Healthcare, LLC
• Merlande Leonna Petithomme, CERTIFIED HAIR LOSS
• Rick Petronella
• Hongduyen Pham, RBT
• David Alexander Phaup
• Janise Phillips
• Matthew Phillips, PHARM.D

• Professional Counselor in Sandy Springs, GA
• Providers in Sandy Springs, GA by specialty
• Professional Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.