Provider Demographics
NPI:1972034122
Name:BEACON OF HOPE, INCORPORATED
Entity Type:Organization
Organization Name:BEACON OF HOPE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WETHERALD
Authorized Official - Suffix:SR
Authorized Official - Credentials:CDP
Authorized Official - Phone:360-385-3866
Mailing Address - Street 1:686 LAKE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2282
Mailing Address - Country:US
Mailing Address - Phone:360-385-3876
Mailing Address - Fax:360-385-7288
Practice Address - Street 1:686 LAKE ST STE 400
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2282
Practice Address - Country:US
Practice Address - Phone:360-385-3876
Practice Address - Fax:360-385-7288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60235589251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health