Provider Demographics
NPI:1952839862
Name:BEDORE, NICHOLE (LCPC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:BEDORE
Suffix:
Gender:F
Credentials:LCPC, LMHC
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:10011 148TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6523
Mailing Address - Country:US
Mailing Address - Phone:773-516-1789
Mailing Address - Fax:
Practice Address - Street 1:4730 UNIVERSITY WAY NE STE 1042019
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4424
Practice Address - Country:US
Practice Address - Phone:773-516-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010852101YM0800X, 101YP2500X
WALH60801971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional