Provider Demographics
NPI:1568974558
Name:MCCALLA, BETHANY MARGARET (NMD)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARGARET
Last Name:MCCALLA
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 S PRICE RD APT 215
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-6161
Mailing Address - Country:US
Mailing Address - Phone:480-352-7262
Mailing Address - Fax:
Practice Address - Street 1:1750 S PRICE RD APT 215
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6161
Practice Address - Country:US
Practice Address - Phone:480-352-7262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1634175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath