Provider Demographics
NPI:1811462724
Name:HALTOM, BETHANY BLAIRE (BHCMII, BHWCII, PRSS)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:BLAIRE
Last Name:HALTOM
Suffix:
Gender:F
Credentials:BHCMII, BHWCII, PRSS
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:BLAIRE
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 TEALWOOD DR APT 1427
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1785
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6100 S WALKER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-7026
Practice Address - Country:US
Practice Address - Phone:405-510-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator