Bethany Basinger Coburn, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

61298 Issued in CA

Practice address

1627 Oak Ave Ste C
Davis, CA 95616-1072

Phone

(773) 678-9975

NPI assigned

May 30, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1559174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559174400000",
    "number": "1912565524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2114 POLLOCK CT",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956187620",
            "telephone_number": "773-678-9975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1627 OAK AVE STE C",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956161072",
            "telephone_number": "773-678-9975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COBURN",
        "first_name": "BETHANY",
        "middle_name": "BASINGER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-05-30",
        "last_updated": "2019-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "61298",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Marie Clegg, D.M.D
• Radiance Clinton
• Bryon D Cloyd, D.C.
• Melinda Coates
• Theodore W Coates, PA-C
• Annette Cody, ANNETTE CODY
• Susan Alice Cohen Byrne, MFT
• Beth Amy Cohen, PH.D.
• Deborah Ellen Cohen, MFT
• Ellen Ruth Cohen, PHD MFT

• Clinical Social Worker in Davis, CA
• Providers in Davis, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.