MEDICARE: MRS. BETHANY HOPE WU MT-BC

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	103TB0200X	Cognitive & Behavioral Psychologist

General Provider Information

NPI Number	:	1912251257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETHANY HOPE WU MT-BC

Provider Business Mailing Address
First Line	:	2005 LAKE BALDWIN LN
Second Line	:	UNIT 310
City	:	ORLANDO
State	:	FL
Zip	:	32814-6931
Country	:	US
Telephone Number	:	601-447-7619
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 LAKE BALDWIN LN
Second Line	:	UNIT 310
City	:	ORLANDO
State	:	FL
Zip	:	32814-6931
Country	:	US
Telephone Number	:	601-447-7619
Fax Number	:

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

Provider Enumeration Date	:	11/08/2012
Last Update Date	:	11/08/2012

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