Provider Demographics
NPI:1639461536
Name:ANDERSON, BETHANY (MS)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9431 COPPERTOP LOOP NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3684
Mailing Address - Country:US
Mailing Address - Phone:206-780-7822
Mailing Address - Fax:206-780-7880
Practice Address - Street 1:9431 COPPERTOP LOOP NE
Practice Address - Street 2:SUITE B
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3684
Practice Address - Country:US
Practice Address - Phone:206-780-7822
Practice Address - Fax:206-780-7880
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60128110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist