Provider Demographics
NPI:1265423362
Name:SHOUDT, BETHANN (PSYD)
Entity type:Individual
Prefix:DR
First Name:BETHANN
Middle Name:
Last Name:SHOUDT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 LONG MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1853
Mailing Address - Country:US
Mailing Address - Phone:610-898-1370
Mailing Address - Fax:
Practice Address - Street 1:4730A PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9521
Practice Address - Country:US
Practice Address - Phone:610-898-1370
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008614L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1695774OtherINDEPENDENCE BC PERSONAL
PA718545OtherAETNA
PA355580OtherHIGHMARK BLUE SHIELD
PA50005216OtherCAPITAL BLUE CROSS
PA355580OtherHIGHMARK BLUE SHIELD