Provider Demographics
NPI:1407090327
Name:BETHANY, YATES & ASSOCAITES
Entity Type:Organization
Organization Name:BETHANY, YATES & ASSOCAITES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:YATES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:871-459-2003
Mailing Address - Street 1:803 STADIUM DR STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6246
Mailing Address - Country:US
Mailing Address - Phone:817-459-2003
Mailing Address - Fax:817-459-1898
Practice Address - Street 1:803 STADIUM DR STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6246
Practice Address - Country:US
Practice Address - Phone:817-459-2003
Practice Address - Fax:817-459-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240211041C0700X
TX247241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty