Individual
BETHANY R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3008 BEVCHER DR, MADISON, IN 47250-3863
(812) 265-1918
(812) 265-1828
Mailing address
606 E MAIN ST, STE 2, MADISON, IN 47250-3689
(812) 339-1691
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
252265
KY
1041C0700X
Clinical Social Worker
Primary
34008720A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
610661458
TAX ID
KY
Enumeration date
07/11/2016
Last updated
01/19/2022
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