Provider Demographics
NPI:1174137608
Name:CHUPP, BETHANY
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:CHUPP
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 1:699 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-2223
Mailing Address - Country:US
Mailing Address - Phone:503-490-5836
Mailing Address - Fax:
Practice Address - Street 1:1820 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-8858
Practice Address - Country:US
Practice Address - Phone:540-724-6132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704009640101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health