Provider Demographics
NPI:1972755536
Name:BETHANY UNIVERSITY COUNSELING CENTER
Entity Type:Organization
Organization Name:BETHANY UNIVERSITY COUNSELING CENTER
Other - Org Name:BETHANY COLLEGE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:GRADUATE PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARBONI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:831-438-3800
Mailing Address - Street 1:800 BETHANY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066
Mailing Address - Country:US
Mailing Address - Phone:831-430-3960
Mailing Address - Fax:831-438-2308
Practice Address - Street 1:800 BETHANY DRIVE
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066
Practice Address - Country:US
Practice Address - Phone:831-430-3960
Practice Address - Fax:831-438-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42703106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty