MEDICARE: BETHANY MARIE WORLEY

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
1	101YM0800X	Mental Health Counselor	MH27846	FL

General Provider Information

NPI Number	:	1467225490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY MARIE WORLEY

Provider Business Mailing Address
First Line	:	260 HICKORY HOLLOW DR S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-3081
Country	:	US
Telephone Number	:	904-412-2651
Fax Number	:

Provider Business Practice Location Address
First Line	:	4114 SUNBEAM RD STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8870
Country	:	US
Telephone Number	:	407-594-7511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	06/04/2026

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