MEDICARE: BETHANY L COMEAU

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
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	64642	TX

General Provider Information

NPI Number	:	1356533467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY L COMEAU

Provider Business Mailing Address
First Line	:	6731 POPPY DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-1871
Country	:	US
Telephone Number	:	602-295-7200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6731 POPPY DR
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-1871
Country	:	US
Telephone Number	:	602-295-7200
Fax Number	:	602-295-7200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	05/10/2013

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Directions to “ BETHANY L COMEAU ” Practice Location

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