Provider Demographics
NPI:1699006692
Name:BETHUNE, KERI STEVENSON (PHD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:STEVENSON
Last Name:BETHUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 ARROWHEAD RD
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8662
Mailing Address - Country:US
Mailing Address - Phone:508-517-1161
Mailing Address - Fax:
Practice Address - Street 1:3202 ARROWHEAD RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8662
Practice Address - Country:US
Practice Address - Phone:508-517-1161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-04-1765103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst