Provider Demographics
NPI:1205091816
Name:TOWNSEND, BETHANY (LCSW)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9385
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37940-0385
Mailing Address - Country:US
Mailing Address - Phone:865-269-2570
Mailing Address - Fax:865-269-2558
Practice Address - Street 1:1009 E RED BUD RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-8807
Practice Address - Country:US
Practice Address - Phone:865-269-2570
Practice Address - Fax:865-269-2558
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ059298Medicaid