Provider Demographics
NPI:1780826032
Name:HART, BETHANY LAURA (MA)
Entity Type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LAURA
Last Name:HART
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11950 FISHERS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2702
Mailing Address - Country:US
Mailing Address - Phone:317-595-5555
Mailing Address - Fax:
Practice Address - Street 1:11950 FISHERS CROSSING DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2702
Practice Address - Country:US
Practice Address - Phone:317-595-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health