Provider Demographics
NPI:1710651229
Name:NEAL, BETHANY JOY (LSWAIC, SUDP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:JOY
Last Name:NEAL
Suffix:
Gender:F
Credentials:LSWAIC, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 NW 140TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1827
Mailing Address - Country:US
Mailing Address - Phone:360-513-9141
Mailing Address - Fax:
Practice Address - Street 1:888 S HILLHURST RD
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:WA
Practice Address - Zip Code:98642-9063
Practice Address - Country:US
Practice Address - Phone:360-857-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC61189456101YM0800X
WACP61146642101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health