Healthcare Provider Details

I. General information

NPI: 1386323434
Provider Name (Legal Business Name): BETHANY MIERTSCHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 S MARENGO AVE
PASADENA CA
91101-3128
US

IV. Provider business mailing address

491 S MARENGO AVE
PASADENA CA
91101-3128
US

V. Phone/Fax

Practice location:
  • Phone: 626-214-5663
  • Fax:
Mailing address:
  • Phone: 626-214-5663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140382
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: