Provider Demographics
NPI:1295968949
Name:BETHUNE, MYA M (PHD)
Entity type:Individual
Prefix:
First Name:MYA
Middle Name:M
Last Name:BETHUNE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MYA
Other - Middle Name:
Other - Last Name:MONHAIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:104 UCB
Mailing Address - Street 2:CENTER FOR COMMUNITY S440
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80309-5001
Mailing Address - Country:US
Mailing Address - Phone:303-492-8096
Mailing Address - Fax:
Practice Address - Street 1:104 UCB
Practice Address - Street 2:CENTER FOR COMMUNITY S440
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309
Practice Address - Country:US
Practice Address - Phone:303-492-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health