Healthcare Provider Details

I. General information

NPI: 1114704574
Provider Name (Legal Business Name): BETHANY HOPE MCRAE M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETHANY HOPE VANVEKOVEN M.S.

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W MAIN ST
NORMAN OK
73069-1312
US

IV. Provider business mailing address

317 W MAIN ST
NORMAN OK
73069-1312
US

V. Phone/Fax

Practice location:
  • Phone: 405-252-0210
  • Fax:
Mailing address:
  • Phone: 405-634-1497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11729
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: