Provider Demographics
NPI:1275276917
Name:HIRAMOTO, BETHANIE
Entity Type:Individual
Prefix:
First Name:BETHANIE
Middle Name:
Last Name:HIRAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 LOIS LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4957
Mailing Address - Country:US
Mailing Address - Phone:502-547-6686
Mailing Address - Fax:
Practice Address - Street 1:3114 LOIS LN
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4957
Practice Address - Country:US
Practice Address - Phone:502-547-6686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5760101YM0800X
TX84810101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health