Provider Demographics
NPI:1477851178
Name:GORKA, BETHANY CATHERINE (MS)
Entity type:Individual
Prefix:MS
First Name:BETHANY
Middle Name:CATHERINE
Last Name:GORKA
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35640 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1628
Mailing Address - Country:US
Mailing Address - Phone:734-729-7792
Mailing Address - Fax:
Practice Address - Street 1:30200 TELEGRAPH RD STE 207
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5711
Practice Address - Country:US
Practice Address - Phone:218-712-1129
Practice Address - Fax:248-792-3249
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000297103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst