Provider Demographics
NPI:1245045301
Name:BETHUNE, ALEXIS MARIE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:MARIE
Last Name:BETHUNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14337 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3401
Mailing Address - Country:US
Mailing Address - Phone:216-284-3255
Mailing Address - Fax:
Practice Address - Street 1:14337 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3401
Practice Address - Country:US
Practice Address - Phone:216-243-6260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator