Healthcare Provider Details

I. General information

NPI: 1912627027
Provider Name (Legal Business Name): BETHANY DANIELLE OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 FAYETTE CTR
WASHINGTON COURT HOUSE OH
43160-2120
US

IV. Provider business mailing address

110 HIGHLAND AVE
CIRCLEVILLE OH
43113-1208
US

V. Phone/Fax

Practice location:
  • Phone: 740-335-8228
  • Fax:
Mailing address:
  • Phone: 740-477-1745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number181388
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: