| Doctor Name: | MS. BETHANIE SUE VANTUYL |
| NPI Number: | 1023441615 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 51236 |
| Business Practice Address: | 109 Manor Ct N Willow Park, TX - 760873002 |
| Business Phone Number: | 8175228263 |
| Business Fax Number: | |
| Mailing Address: | P.o. Box 796, KENNEDALE |
| State: | TX |
| Postal Code: | 760603267 |
| Phone Number: | 4694751650 |
| Fax Number: | |
| NPI Enumeration Date: | 08/19/2013 |
| NPI Last Update Date: | 08/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 51236 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |