Individual
BETHANY MIRIYA THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3200 SOUTHWEST FWY, HOUSTON, TX 77027-7528
(860) 933-6765
Mailing address
220 ATHENS WAY STE 240, NASHVILLE, TN 37228-1311
(833) 208-7770
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2016001149
MO
1041C0700X
Clinical Social Worker
0904010673
VA
1041C0700X
Clinical Social Worker
100806
IA
1041C0700X
Clinical Social Worker
Primary
104593
TX
1041C0700X
Clinical Social Worker
13716
SC
1041C0700X
Clinical Social Worker
8936-C
NV
1041C0700X
Clinical Social Worker
C011448
NC
1041C0700X
Clinical Social Worker
SW21586
FL
Other
Enumeration date
01/16/2017
Last updated
11/15/2024
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