Provider Demographics
NPI:1093167553
Name:BERENS, BETHANY DIANE (LMHCA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:DIANE
Last Name:BERENS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 SW HOLDEN ST APT A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-3487
Mailing Address - Country:US
Mailing Address - Phone:206-317-4688
Mailing Address - Fax:
Practice Address - Street 1:600 N 36TH ST STE 218
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-8697
Practice Address - Country:US
Practice Address - Phone:206-317-4688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60650995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health