Provider Demographics
NPI:1003152836
Name:SHAKESPEARE, BETHANY J (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:SHAKESPEARE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:J
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:209 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-3780
Mailing Address - Country:US
Mailing Address - Phone:559-716-1980
Mailing Address - Fax:
Practice Address - Street 1:209 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3780
Practice Address - Country:US
Practice Address - Phone:559-716-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-26
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 72262106H00000X
CA100056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist