Provider Demographics
NPI:1023441615
Name:WOOTEN, BETHANIE SUE (LCSW)
Entity type:Individual
Prefix:MS
First Name:BETHANIE
Middle Name:SUE
Last Name:WOOTEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:BETHANIE
Other - Middle Name:
Other - Last Name:VANTUYL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5380 GULF OF MEXICO DR
Mailing Address - Street 2:STE 105
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-2048
Mailing Address - Country:US
Mailing Address - Phone:469-475-1650
Mailing Address - Fax:
Practice Address - Street 1:5380 GULF OF MEXICO DR STE 105
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-2048
Practice Address - Country:US
Practice Address - Phone:469-475-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX512361041C0700X
FLSW152951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical