Provider Demographics
NPI:1508690611
Name:EARL, BETHANY (PHD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:EARL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3554 EL CAMINO RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1107
Mailing Address - Country:US
Mailing Address - Phone:760-362-3543
Mailing Address - Fax:
Practice Address - Street 1:3554 EL CAMINO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-1107
Practice Address - Country:US
Practice Address - Phone:760-362-3543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101Y00000XBehavioral Health & Social Service ProvidersCounselor