Provider Demographics
NPI:1174864052
Name:COLAPRETE, BETHANY S (MED, LPC)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:S
Last Name:COLAPRETE
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:LENORE
Mailing Address - State:ID
Mailing Address - Zip Code:83541-5095
Mailing Address - Country:US
Mailing Address - Phone:208-431-9119
Mailing Address - Fax:
Practice Address - Street 1:212 RODEO DR
Practice Address - Street 2:SUITE 410
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9798
Practice Address - Country:US
Practice Address - Phone:208-882-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5059101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional