Healthcare Provider Details

I. General information

NPI: 1003567660
Provider Name (Legal Business Name): BETHANY MAE KILLIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 N DREAMY DRAW DR STE 145
PHOENIX AZ
85020-4668
US

IV. Provider business mailing address

7500 N DREAMY DRAW DR STE 145
PHOENIX AZ
85020-4668
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-4545
  • Fax:
Mailing address:
  • Phone: 480-882-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number283014
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23837
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: