Provider Demographics
NPI:1790807386
Name:JORAM, BETTE R (PH D)
Entity Type:Individual
Prefix:
First Name:BETTE
Middle Name:R
Last Name:JORAM
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 23RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1312
Mailing Address - Country:US
Mailing Address - Phone:206-937-6831
Mailing Address - Fax:206-937-6831
Practice Address - Street 1:4420 23RD AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1312
Practice Address - Country:US
Practice Address - Phone:206-937-6831
Practice Address - Fax:206-937-6831
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALH00006245OtherLICENSED MENTAL HEALTH CO