Provider Demographics
NPI:1477122091
Name:PEREZ, BETHANY MARIE (CSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WHISPERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-9214
Mailing Address - Country:US
Mailing Address - Phone:303-594-0059
Mailing Address - Fax:
Practice Address - Street 1:44 WHISPERWOOD LN
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-9214
Practice Address - Country:US
Practice Address - Phone:303-594-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11611229-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical