Provider Demographics
NPI:1356591705
Name:BETHAY, JEFFRY SCOTT (PHD)
Entity type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:SCOTT
Last Name:BETHAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PRIVATE ROAD 3151
Mailing Address - Street 2:APARTMENT 7
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-7004
Mailing Address - Country:US
Mailing Address - Phone:662-801-7828
Mailing Address - Fax:
Practice Address - Street 1:34 PRIVATE ROAD 3151
Practice Address - Street 2:APARTMENT 7
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-7004
Practice Address - Country:US
Practice Address - Phone:662-801-7828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2010-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS50-868103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical