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General NPI Number Information
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NPI Number | 1689097925
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Entity Type | Individual
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Provider Name | BETHANY HOLDER M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/22/2014
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Last Update Date | 10/25/2014
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Provider Practice Location Address
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Address Line | 616 S EL CAMINO REAL SUITE G-9
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4298
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Country | US
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Telephone | 949-427-1104
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Fax |
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Provider Business Mailing Address
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Address Line | 55 HALF MOON TRL
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City | LADERA RANCH
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State | CA
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Zip | 92694-0215
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Country | US
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Telephone | 949-842-7884
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Fax | 949-364-6334
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 52156
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License Number State | CA
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