Provider Demographics
NPI:1689122582
Name:CHRISTIAN, BETHANY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 MONARCH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40513-1843
Mailing Address - Country:US
Mailing Address - Phone:859-368-0609
Mailing Address - Fax:
Practice Address - Street 1:1030 MONARCH ST
Practice Address - Street 2:STE 100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1843
Practice Address - Country:US
Practice Address - Phone:859-368-0609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY166495103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical