Individual
BETHANY LACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSW
Contact information
Practice address
1990 LOUISVILLE RD STE 107, BOWLING GREEN, KY 42101-1202
(270) 904-0055
(270) 904-5110
Mailing address
1990 LOUISVILLE RD STE 107, BOWLING GREEN, KY 42101-1202
(270) 904-0055
(270) 904-5110
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6100
KY
Other
Enumeration date
05/13/2020
Last updated
05/13/2020
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