Provider Demographics
NPI:1588849814
Name:KEITH, BETHANY L (LCSW)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:KEITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5410 HOMBERG DR STE 31
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-5045
Mailing Address - Country:US
Mailing Address - Phone:865-330-0021
Mailing Address - Fax:865-766-0182
Practice Address - Street 1:5410 HOMBERG DR STE 31
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5045
Practice Address - Country:US
Practice Address - Phone:865-330-0021
Practice Address - Fax:865-766-0182
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical