Healthcare Provider Details

I. General information

NPI: 1285354522
Provider Name (Legal Business Name): BETHANY EBLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 HATCHER LN STE A
CLARKSVILLE TN
37043-5921
US

IV. Provider business mailing address

773 GLEASON DR
CLARKSVILLE TN
37042-1123
US

V. Phone/Fax

Practice location:
  • Phone: 931-444-1449
  • Fax:
Mailing address:
  • Phone: 931-419-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: