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NPI Code Detail

MEDICARE: BETHANY FELISA MIRACLE-LARSON RESIDENT

MEDICARE: BETHANY FELISA MIRACLE-LARSON RESIDENT
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
1101Y00000XCounselor0704010024VA

General Provider Information

NPI Number : 1558752626
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY FELISA MIRACLE-LARSON RESIDENT
Provider Business Mailing Address
First Line : 1208 E CHURCHVILLE RD STE 300
Second Line :
City : BEL AIR
State : MD
Zip : 21014-3485
Country : US
Telephone Number : 410-893-4600
Fax Number : 443-640-4358
Provider Business Practice Location Address
First Line : 1208 E CHURCHVILLE RD STE 300
Second Line :
City : BEL AIR
State : MD
Zip : 21014-3485
Country : US
Telephone Number : 410-893-4600
Fax Number : 410-995-7846
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2015
Last Update Date : 02/04/2019

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Directions to “ BETHANY FELISA MIRACLE-LARSON RESIDENT” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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