Provider Demographics
NPI:1053058321
Name:NIETO, BETHSHEBA ALEXANDER (LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:BETHSHEBA
Middle Name:ALEXANDER
Last Name:NIETO
Suffix:
Gender:F
Credentials:LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 OAK LN
Mailing Address - Street 2:
Mailing Address - City:LILY
Mailing Address - State:KY
Mailing Address - Zip Code:40740-3388
Mailing Address - Country:US
Mailing Address - Phone:606-231-7957
Mailing Address - Fax:
Practice Address - Street 1:80 HIGHWAY 2227
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1562
Practice Address - Country:US
Practice Address - Phone:937-475-2702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY268447101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY268447OtherLPCA, NCC