Provider Demographics
NPI:1558047829
Name:JOHNSON, BETHANY RUTH (MS, CGC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:RUTH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 S HETTEMA ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4317
Mailing Address - Country:US
Mailing Address - Phone:928-750-2443
Mailing Address - Fax:
Practice Address - Street 1:2375 S RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8868
Practice Address - Country:US
Practice Address - Phone:928-336-1927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS