Individual
BETHANY S GOURLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
19855 OUTER DR STE 300, DEARBORN, MI 48124-2022
(313) 359-1977
Mailing address
19855 OUTER DR STE 300, DEARBORN, MI 48124-2022
(313) 359-1977
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301019229
MI
103TC0700X
Clinical Psychologist
Primary
6301019229
MI
Other
Enumeration date
06/10/2020
Last updated
08/22/2023
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