Provider Demographics
NPI:1952678302
Name:MEAD, BETHANY
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21171 CONSER RD
Mailing Address - Street 2:
Mailing Address - City:HODGEN
Mailing Address - State:OK
Mailing Address - Zip Code:74939
Mailing Address - Country:US
Mailing Address - Phone:918-653-3470
Mailing Address - Fax:
Practice Address - Street 1:21171 CONSER RD
Practice Address - Street 2:
Practice Address - City:HODGEN
Practice Address - State:OK
Practice Address - Zip Code:74939
Practice Address - Country:US
Practice Address - Phone:918-653-3470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health