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NPI Code Detail

MEDICARE: BETHANY RUSNAK LMFT

MEDICARE: BETHANY RUSNAK LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMT3155FL

General Provider Information

NPI Number : 1245515519
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY RUSNAK LMFT
Provider Business Mailing Address
First Line : 2702 W BALLAST POINT BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33611-4002
Country : US
Telephone Number : 850-814-8292
Fax Number :
Provider Business Practice Location Address
First Line : 7821 N DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33614-3275
Country : US
Telephone Number : 813-443-4827
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2011
Last Update Date : 07/28/2020

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