Provider Demographics
NPI:1053547810
Name:BERNTHALER, BETH A (LMHP, LIMHP, LADC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BERNTHALER
Suffix:
Gender:F
Credentials:LMHP, LIMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 MIRACLE HILLS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4467
Mailing Address - Country:US
Mailing Address - Phone:402-238-1431
Mailing Address - Fax:402-281-1862
Practice Address - Street 1:11605 MIRACLE HILLS DR STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4467
Practice Address - Country:US
Practice Address - Phone:402-238-1431
Practice Address - Fax:402-281-1862
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3480101Y00000X
NE1094101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660626Medicaid
NE47037660624Medicaid
NE47037660631Medicaid