Provider Demographics
NPI:1326796707
Name:DAVIS, BETHANY NICOLE (MSBS, LMFT-CANDIDATE)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSBS, LMFT-CANDIDATE
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:NICOLE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:283 NE CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:OK
Mailing Address - Zip Code:73538-5021
Mailing Address - Country:US
Mailing Address - Phone:270-307-4698
Mailing Address - Fax:
Practice Address - Street 1:602 SW 38TH ST
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6912
Practice Address - Country:US
Practice Address - Phone:580-248-5780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist