Provider Demographics
NPI:1992405443
Name:PALMER, BETHANY (MSW, SWLC)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:MSW, SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 BUCKRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6150
Mailing Address - Country:US
Mailing Address - Phone:406-599-6246
Mailing Address - Fax:
Practice Address - Street 1:1714 BUCKRAKE AVE
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6150
Practice Address - Country:US
Practice Address - Phone:406-599-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-62185104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker