Provider Demographics
NPI:1174860282
Name:BETHEL PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:BETHEL PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJIBADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-542-9385
Mailing Address - Street 1:5062 S ESPANA CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-5805
Mailing Address - Country:US
Mailing Address - Phone:646-542-9385
Mailing Address - Fax:303-766-8374
Practice Address - Street 1:5062 S ESPANA CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-5805
Practice Address - Country:US
Practice Address - Phone:303-766-5074
Practice Address - Fax:303-766-8374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHEL PSYCHIATRIC SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty