Provider Demographics
NPI:1003323445
Name:BOSIER, BETHANY MICHELLE
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MICHELLE
Last Name:BOSIER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:MICHELLE
Other - Last Name:SOLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10245 E VIA LINDA STE 225
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5345
Mailing Address - Country:US
Mailing Address - Phone:480-687-3435
Mailing Address - Fax:480-687-7061
Practice Address - Street 1:10245 E VIA LINDA STE 225
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5345
Practice Address - Country:US
Practice Address - Phone:480-687-3435
Practice Address - Fax:480-687-7061
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-155248101YA0400X
AZLPC-20774101Y00000X
TX79520101Y00000X
NVCP5567-R101Y00000X
TX15017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)