Healthcare Provider Details

I. General information

NPI: 1093172793
Provider Name (Legal Business Name): BETHANY MAHLER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2016
Last Update Date: 10/27/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PROSPECT ST FL 3
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

1 S PROSPECT ST FL 3
BURLINGTON VT
05401-3456
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-1421
  • Fax: 802-847-3326
Mailing address:
  • Phone: 802-847-1421
  • Fax: 802-847-3326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0109513
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151.0127136
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: