Healthcare Provider Details

I. General information

NPI: 1609275304
Provider Name (Legal Business Name): BETHANIE WENKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 CABOT BLVD W
LANGHORNE PA
19047-1885
US

IV. Provider business mailing address

2450 FONDREN RD STE 312
HOUSTON TX
77063-2323
US

V. Phone/Fax

Practice location:
  • Phone: 267-587-2300
  • Fax:
Mailing address:
  • Phone: 713-789-7560
  • Fax: 713-789-7351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number41147
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number41147
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: