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NPI Code Detail

MEDICARE: SHAWNA R BETHEL IMF

MEDICARE: SHAWNA R BETHEL IMF
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1427126796
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWNA R BETHEL IMF
Provider Business Mailing Address
First Line : 892 27TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-1444
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 892 27TH ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92154-1444
Country : US
Telephone Number : 619-575-4687
Fax Number : 619-575-1215
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2006
Last Update Date : 07/08/2007

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Directions to “ SHAWNA R BETHEL IMF” Practice Location

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