Provider Demographics
NPI:1740744739
Name:MCFALL, BETHANY (RBT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MCFALL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:R
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2031 OAK MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8822
Mailing Address - Country:US
Mailing Address - Phone:386-348-1275
Mailing Address - Fax:
Practice Address - Street 1:23 RYBAR LN
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6445
Practice Address - Country:US
Practice Address - Phone:386-316-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-19-75996106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician