Provider Demographics
NPI:1881456010
Name:POGUE, BETHANY ANN
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANN
Last Name:POGUE
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 1:9603 FOREST HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-4943
Mailing Address - Country:US
Mailing Address - Phone:713-614-2040
Mailing Address - Fax:
Practice Address - Street 1:3711 GARTH RD STE 160
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3176
Practice Address - Country:US
Practice Address - Phone:713-730-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician