Provider Demographics
NPI:1457860538
Name:SUPPES, BETHANY (LMFT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:SUPPES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 MEDLIN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-2360
Mailing Address - Country:US
Mailing Address - Phone:817-437-1349
Mailing Address - Fax:
Practice Address - Street 1:3015 MEDLIN DR STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2360
Practice Address - Country:US
Practice Address - Phone:817-437-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202436106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist