Provider Demographics
NPI:1538417902
Name:MILLS, BETHANY (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WILDFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-8837
Mailing Address - Country:US
Mailing Address - Phone:815-278-0201
Mailing Address - Fax:
Practice Address - Street 1:30 WILDFLOWER DR
Practice Address - Street 2:
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-8837
Practice Address - Country:US
Practice Address - Phone:815-278-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY129726103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical