Provider Demographics
NPI:1639295785
Name:LINDAL, BETHANIE NELSON (MSW LCSW, CSPT)
Entity Type:Individual
Prefix:MR
First Name:BETHANIE
Middle Name:NELSON
Last Name:LINDAL
Suffix:
Gender:F
Credentials:MSW LCSW, CSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4496
Mailing Address - Street 2:171 BEECHER STREET
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631-4496
Mailing Address - Country:US
Mailing Address - Phone:970-328-7378
Mailing Address - Fax:
Practice Address - Street 1:171 BEECHER STREET
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-4496
Practice Address - Country:US
Practice Address - Phone:970-328-7378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical