Provider Demographics
NPI:1700285806
Name:KINMONTH, BETHANNE
Entity Type:Individual
Prefix:MRS
First Name:BETHANNE
Middle Name:
Last Name:KINMONTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 S JACKSON ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3802
Mailing Address - Country:US
Mailing Address - Phone:206-915-8694
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3802
Practice Address - Country:US
Practice Address - Phone:206-915-8694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2019-03-09
Deactivation Date:2019-02-27
Deactivation Code:
Reactivation Date:2019-03-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA45-455-7810OtherEIN
WA602 739 763OtherUBI