Provider Demographics
NPI:1316491061
Name:DETWILER, BETHANY (PHD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:DETWILER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N CEDAR CREST BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4664
Mailing Address - Country:US
Mailing Address - Phone:610-467-3736
Mailing Address - Fax:
Practice Address - Street 1:121 N CEDAR CREST BLVD STE A
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4664
Practice Address - Country:US
Practice Address - Phone:610-467-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling