Provider Demographics
NPI:1134402639
Name:HENDRICKSON, BETHANY J (MA, LMHC, MHP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:J
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:MA, LMHC, MHP
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:J
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11320 ROOSEVELT WAY NE
Mailing Address - Street 2:C/O NORTHWEST FAMILY LIFE
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6228
Mailing Address - Country:US
Mailing Address - Phone:360-820-2557
Mailing Address - Fax:206-363-9639
Practice Address - Street 1:11320 ROOSEVELT WAY NE
Practice Address - Street 2:C/O NORTHWEST FAMILY LIFE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-6228
Practice Address - Country:US
Practice Address - Phone:360-820-2557
Practice Address - Fax:206-363-9639
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60511822101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health