Provider Demographics
NPI:1720810062
Name:HENTKOWSKI, BETHANY MARIE
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:HENTKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANI
Other - Middle Name:MARIE
Other - Last Name:HENTKOWSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1700 GAUCHO CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8211
Mailing Address - Country:US
Mailing Address - Phone:303-747-3480
Mailing Address - Fax:
Practice Address - Street 1:229 TERRY ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5930
Practice Address - Country:US
Practice Address - Phone:303-747-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health