Individual
BETHANY A MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
812 CHESTNUT ST, CANON CITY, CO 81212-4730
(719) 369-6026
Mailing address
812 CHESTNUT ST, CANON CITY, CO 81212-4730
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPCC.0021762
CO
Other
Enumeration date
03/06/2024
Last updated
03/06/2024
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