Bethany Kientzel
Individual provider Active NPI Marriage & Family Therapist · Santa Cruz, CA
NPI 1902201072 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1902201072
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 10221072 (CA)
- Practice address
- 340 Soquel Ave Ste 105
Santa Cruz, CA 95062-2328 - Phone
- (831) 429-6399
- NPI assigned
- Oct 30, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Marriage and Family Therapist
- Education
- Other, 2005
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
Santa Cruz, CA 95060
Phone (831) 429-6399
3343 PO Box
Santa Cruz, CA 95063
340 Soquel Ave
Suite 101
Santa Cruz, CA 95062-2328
Phone (831) 429-6399
PO Box
Suite 3343
Santa Cruz, CA 95063
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251016003791 | CA | Practitioner - Marriage and Family Therapist | 4183111602 | Practice locations: Santa Cruz, CA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10221072 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Center for Humanistic Development | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 10221072 | CA | Yes |
Addresses
Primary practice location
340 Soquel Ave Ste 105
Santa Cruz, CA 95062-2328
Mailing address
PO Box 3343
Santa Cruz, CA 95063-3343
Phone (831) 429-6399
Other practice location 1
6233 Soquel Dr
Aptos, CA 95003-3184
Phone (831) 784-5662
Other providers in Santa Cruz, CA
- Dean Jal Khambatta
- Amina M Khan
- Ayub Khan
- Trisha Khanna
- Kim Khuc
- Amanda Kight
- Gaye Kihorany
- Peadar Killeen
- Megan Kilmer
- Audrey Kim
All providers in Santa Cruz, CA · Marriage & Family Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.