Provider Demographics
NPI:1992015051
Name:HOUSEHOLDER, BETH MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:MARIE
Last Name:HOUSEHOLDER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E DEBBIE LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9240
Mailing Address - Country:US
Mailing Address - Phone:972-825-1494
Mailing Address - Fax:
Practice Address - Street 1:250 E DEBBIE LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9240
Practice Address - Country:US
Practice Address - Phone:972-825-1494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108730225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist