Healthcare Provider Details

I. General information

NPI: 1912854803
Provider Name (Legal Business Name): JOANNA K. BETHEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 N 100 W
BLANDING UT
84511-3563
US

IV. Provider business mailing address

987 N 100 W
BLANDING UT
84511-3563
US

V. Phone/Fax

Practice location:
  • Phone: 435-260-1318
  • Fax:
Mailing address:
  • Phone: 435-260-1318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14273665-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: