Healthcare Provider Details

I. General information

NPI: 1689122582
Provider Name (Legal Business Name): BETHANY CHRISTIAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 MONARCH ST STE 100
LEXINGTON KY
40513-1843
US

IV. Provider business mailing address

1030 MONARCH ST STE 100
LEXINGTON KY
40513-1843
US

V. Phone/Fax

Practice location:
  • Phone: 859-368-0609
  • Fax:
Mailing address:
  • Phone: 859-368-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number170917
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: