Provider Demographics
NPI:1851691836
Name:GARCIA, BETHANY A
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:A
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:HASAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4721 S CLIFF AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6969
Mailing Address - Country:US
Mailing Address - Phone:816-606-1956
Mailing Address - Fax:800-687-5070
Practice Address - Street 1:248 NE BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2722
Practice Address - Country:US
Practice Address - Phone:816-608-1951
Practice Address - Fax:800-687-5070
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLBA116103K00000X
MO2017003589103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst