Bethany Moore Polk, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

66357 Issued in TX

Practice address

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504

Phone

(210) 916-7500

NPI assigned

Jun 24, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Usawa Wellness Services

  • Mental Health Counselor
  • Live Oak, TX
  • NPI 1588185821
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743465600000",
    "number": "1619711645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3016 GREENSHIRE DR",
            "city": "SCHERTZ",
            "state": "TX",
            "postal_code": "781543708",
            "telephone_number": "254-289-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3016 Greenshire Dr",
            "address_purpose": "LOCATION",
            "city": "Schertz",
            "state": "TX",
            "postal_code": "781543708",
            "country_code": "US",
            "telephone_number": "254-289-7783",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11901 Toepperwein Rd Ste 1202",
            "address_purpose": "LOCATION",
            "city": "Live Oak",
            "state": "TX",
            "postal_code": "782333159",
            "country_code": "US",
            "telephone_number": "210-951-3479",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLK",
        "first_name": "BETHANY",
        "middle_name": "MOORE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-24",
        "last_updated": "2025-04-01",
        "certification_date": "2025-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "66357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Idaly Pino, LCSW
• Mason Plese, DO
• Natalia Anna Pluta, MD
• Matthew Scott Poe, PA-C
• Noel Gerard Poindexter, MSN-CRNA
• Jonathan Z Pollard, DO
• Catherine Coss Polley, MD, MPH
• Jennifer Polyniak, PHARMD
• Carrie Mae Pommeranz, OTD, OTR
• Lauren Ponko Brownlee

• Clinical Social Worker in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• Clinical Social Worker in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.