Active NPI
Bethany Michele Hanczor, LPC-MHSP
- Professional Counselor
- Memphis, TN
National Provider Identifier
1619115201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 4002
- Practice address
- 661 Madison Ave
Memphis, TN 38103-3307 - Phone
- (901) 267-4008
- Fax
- (901) 267-4099
- NPI assigned
- Feb 4, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Professional Counselor | 101YP2500X | 4002 | TN | Primary |
Addresses
Primary practice location
661 Madison Ave
Memphis, TN 38103-3307
Mailing address
661 Madison Ave
Memphis, TN 38103-3307
Phone (901) 267-4008
Other names 1
- Bethany Michele Godwin
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4002 | TN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Omni Community Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Memphis, TN
- NPI 1316320880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684713600000",
"number": "1619115201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "661 MADISON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381033307",
"telephone_number": "901-267-4008",
"fax_number": "901-267-4099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "661 MADISON AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381033307",
"telephone_number": "901-267-4008",
"fax_number": "901-267-4099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANCZOR",
"first_name": "BETHANY",
"middle_name": "MICHELE",
"name_prefix": "Mrs.",
"credential": "LPC-MHSP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-02-04",
"last_updated": "2023-05-22",
"certification_date": "2023-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TN",
"license": "4002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BETHANY",
"last_name": "GODWIN",
"middle_name": "MICHELE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2023; 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.