Provider Demographics
NPI:1063165611
Name:SANDERS, BETHANY CARROLL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:CARROLL
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 SHANNON DR
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2438
Mailing Address - Country:US
Mailing Address - Phone:972-839-6372
Mailing Address - Fax:
Practice Address - Street 1:1548 SHANNON DR
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2438
Practice Address - Country:US
Practice Address - Phone:972-839-6372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX553481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty