Provider Demographics
NPI:1356533467
Name:COMEAU, BETHANY L
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:L
Last Name:COMEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6731 POPPY DR
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-1871
Mailing Address - Country:US
Mailing Address - Phone:602-295-7200
Mailing Address - Fax:
Practice Address - Street 1:6731 POPPY DR
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-1871
Practice Address - Country:US
Practice Address - Phone:602-295-7200
Practice Address - Fax:602-295-7200
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX64642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health