Provider Demographics
NPI:1508389347
Name:BETH WILSON, PHD
Entity Type:Organization
Organization Name:BETH WILSON, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-802-5232
Mailing Address - Street 1:1621 114TH AVE SE STE 221
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6905
Mailing Address - Country:US
Mailing Address - Phone:425-802-5232
Mailing Address - Fax:425-688-9987
Practice Address - Street 1:1621 114TH AVE SE STE 221
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6905
Practice Address - Country:US
Practice Address - Phone:425-802-5232
Practice Address - Fax:425-688-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00002288103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty