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General NPI Number Information
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NPI Number | 1861376683
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Entity Type | Individual
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Provider Name | BETHANY K GARVON
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 220 W PINE ST
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City | FREMONT
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State | MI
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Zip | 49412-1532
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Country | US
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Telephone | 231-689-7330
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Fax | 231-689-7345
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Provider Business Mailing Address
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Address Line | 208 E 82ND ST APT A3
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City | NEWAYGO
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State | MI
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Zip | 49337-9668
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Country | US
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Telephone | 231-580-9995
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Fax | 231-580-9995
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State | MI
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