Provider Demographics
NPI:1073053104
Name:BETHANY NAGEL THERAPY
Entity Type:Organization
Organization Name:BETHANY NAGEL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-518-6870
Mailing Address - Street 1:2128 EASTRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3434
Mailing Address - Country:US
Mailing Address - Phone:301-518-6870
Mailing Address - Fax:
Practice Address - Street 1:1200 E JOPPA RD
Practice Address - Street 2:SUITE A1
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5810
Practice Address - Country:US
Practice Address - Phone:301-518-6870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6296251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health