Provider Demographics
NPI:1912251257
Name:WU, BETHANY HOPE (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:HOPE
Last Name:WU
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 LAKE BALDWIN LN
Mailing Address - Street 2:UNIT 310
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6931
Mailing Address - Country:US
Mailing Address - Phone:601-447-7619
Mailing Address - Fax:
Practice Address - Street 1:2005 LAKE BALDWIN LN
Practice Address - Street 2:UNIT 310
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32814-6931
Practice Address - Country:US
Practice Address - Phone:601-447-7619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral