Provider Demographics
NPI:1730108408
Name:BETHANY, CYNTHIA L (LCSW, CTS)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:BETHANY
Suffix:
Gender:F
Credentials:LCSW, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 STADIUM DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-6246
Mailing Address - Country:US
Mailing Address - Phone:817-459-2003
Mailing Address - Fax:817-459-1898
Practice Address - Street 1:803 STADIUM DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6246
Practice Address - Country:US
Practice Address - Phone:817-459-2003
Practice Address - Fax:817-459-1898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical