MEDICARE: BETHANY EARL PHD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	171400000X	Health & Wellness Coach
2	101Y00000X	Counselor
3	101YP1600X	Pastoral Counselor	NV

General Provider Information

NPI Number	:	1508690611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY EARL PHD

Provider Business Mailing Address
First Line	:	3554 EL CAMINO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1107
Country	:	US
Telephone Number	:	760-362-3543
Fax Number	:

Provider Business Practice Location Address
First Line	:	3554 EL CAMINO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1107
Country	:	US
Telephone Number	:	760-362-3543
Fax Number	:

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

Provider Enumeration Date	:	08/29/2024
Last Update Date	:	10/19/2025

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