Healthcare Provider Details

I. General information

NPI: 1942880117
Provider Name (Legal Business Name): BETHANY CHRISTIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 E COLLEGE AVE STE A
STATE COLLEGE PA
16801-7204
US

IV. Provider business mailing address

2147 E COLLEGE AVE STE A
STATE COLLEGE PA
16801-7204
US

V. Phone/Fax

Practice location:
  • Phone: 814-867-2828
  • Fax: 814-867-2828
Mailing address:
  • Phone: 814-867-2828
  • Fax: 814-867-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LISA STOUTMEYER
Title or Position: BILLER
Credential:
Phone: 616-224-7429