Provider Demographics
NPI:1649916677
Name:JUSTIN BETHONEY NP INTEGRATIVE PSYCHIATRIC NURSING, INC.
Entity type:Organization
Organization Name:JUSTIN BETHONEY NP INTEGRATIVE PSYCHIATRIC NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BETHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-920-1677
Mailing Address - Street 1:19528 SAGER LOOP
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9810
Mailing Address - Country:US
Mailing Address - Phone:310-920-1677
Mailing Address - Fax:224-215-3993
Practice Address - Street 1:243 SCALEHOUSE LOOP STE 4
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1276
Practice Address - Country:US
Practice Address - Phone:458-206-6251
Practice Address - Fax:224-215-3993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty