Provider Demographics
NPI:1144656943
Name:BETHANY CHRISTIAN SERVICES
Entity type:Organization
Organization Name:BETHANY CHRISTIAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BRANCH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:601-366-4282
Mailing Address - Street 1:2624 SOUTHERLAND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4825
Mailing Address - Country:US
Mailing Address - Phone:601-366-4282
Mailing Address - Fax:601-366-4287
Practice Address - Street 1:2624 SOUTHERLAND ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4825
Practice Address - Country:US
Practice Address - Phone:601-366-4282
Practice Address - Fax:601-366-4287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM0518104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty