Provider Demographics
NPI:1619590676
Name:CORBIN, BETHANY H (LSW, LCDCIII)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:H
Last Name:CORBIN
Suffix:
Gender:F
Credentials:LSW, LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 STATE ROUTE 160
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:OH
Mailing Address - Zip Code:45686-9009
Mailing Address - Country:US
Mailing Address - Phone:740-245-3051
Mailing Address - Fax:740-245-3052
Practice Address - Street 1:11821 STATE ROUTE 160
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:OH
Practice Address - Zip Code:45686-9009
Practice Address - Country:US
Practice Address - Phone:740-245-3051
Practice Address - Fax:740-245-3052
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLCDCIII.162323101YA0400X
OHS.2208488101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0405044Medicaid