Provider Demographics
NPI:1497271811
Name:HOUSTON, BETHANY HANNAH (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:HANNAH
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 741
Mailing Address - Street 2:
Mailing Address - City:CANDOR
Mailing Address - State:NC
Mailing Address - Zip Code:27229-0741
Mailing Address - Country:US
Mailing Address - Phone:270-871-8136
Mailing Address - Fax:336-610-0209
Practice Address - Street 1:904 S COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-6466
Practice Address - Country:US
Practice Address - Phone:336-626-0208
Practice Address - Fax:336-610-0209
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13247101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty