Provider Demographics
NPI:1902783558
Name:OUTLAND, BETHANY L
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:OUTLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CHAMBER CENTER DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1604
Mailing Address - Country:US
Mailing Address - Phone:270-839-2040
Mailing Address - Fax:
Practice Address - Street 1:2500 CHAMBER CENTER DR STE 301
Practice Address - Street 2:
Practice Address - City:LAKESIDE PARK
Practice Address - State:KY
Practice Address - Zip Code:41017-1604
Practice Address - Country:US
Practice Address - Phone:270-839-2040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY256380101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health