Healthcare Provider Details

I. General information

NPI: 1629652268
Provider Name (Legal Business Name): BETHANY HOPE MARION MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2427 RUSSELLVILLE RD
BOWLING GREEN KY
42101-3980
US

IV. Provider business mailing address

PO BOX 737441
CHICAGO IL
60673-7441
US

V. Phone/Fax

Practice location:
  • Phone: 270-936-7472
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1490
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number310025
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: