Healthcare Provider Details

I. General information

NPI: 1114520277
Provider Name (Legal Business Name): BETHANY ANN MATTHEWS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 E GEORGIA RD
WOODRUFF SC
29388-8787
US

IV. Provider business mailing address

260 ROCK CREEK RD
CLEMSON SC
29631-1940
US

V. Phone/Fax

Practice location:
  • Phone: 864-676-0028
  • Fax:
Mailing address:
  • Phone: 803-480-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: