Organization
BETHANY FOR CHILDREN & FAMILIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA CHRISTOPHER (CONTRACTING & CREDENTIALING COORDIN)
(563) 327-0203
Entity
Organization
Contact information
Practice address
1701 RIVER DR STE 200, MOLINE, IL 61265-1384
(309) 797-7700
(309) 797-2386
Mailing address
1701 RIVER DR, MOLINE, IL 61265-1384
(309) 797-7700
(309) 797-2386
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YS0200X
School Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
1041S0200X
School Social Worker
—
—
122300000X
Dentist
—
—
1223D0001X
Public Health Dentistry
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
126900000X
Dental Laboratory Technician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104307
—
IA
05
—
1B00-IPI-014
—
IL
05
—
310510
—
IL
Enumeration date
03/17/2006
Last updated
04/11/2025
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