Provider Demographics
NPI:1134547193
Name:NELSON, BETHANY GRACE (BCABA)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:GRACE
Last Name:NELSON
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19201 SE 263RD ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-6020
Mailing Address - Country:US
Mailing Address - Phone:360-929-0717
Mailing Address - Fax:
Practice Address - Street 1:3100 NW BUCKLIN HILL RD STE 224
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8365
Practice Address - Country:US
Practice Address - Phone:360-536-3060
Practice Address - Fax:347-823-9717
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0-14-5775106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst