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General NPI Number Information
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NPI Number | 1013877075
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Entity Type | Individual
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Provider Name | BETHELEM CHUOL THOK
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Gender | Female
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 2208 N WEBB RD # UNITS4
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City | GRAND ISLAND
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State | NE
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Zip | 68803-1754
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Country | US
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Telephone | 308-381-1690
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Fax |
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Provider Business Mailing Address
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Address Line | 415 S CHERRY ST APT H45
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City | GRAND ISLAND
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State | NE
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Zip | 68801-1905
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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