Provider Demographics
NPI:1881177319
Name:CRAIG, BETHANY ANN
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:CRAIG
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 1:4629 AICHOLTZ RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-1560
Mailing Address - Country:US
Mailing Address - Phone:513-752-1555
Mailing Address - Fax:
Practice Address - Street 1:4629 AICHOLTZ RD STE 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1560
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-10-11
Deactivation Date:2018-09-14
Deactivation Code:
Reactivation Date:2018-10-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health