Provider Demographics
NPI:1750967600
Name:BETHE, ADDY LYNETTE
Entity type:Individual
Prefix:
First Name:ADDY
Middle Name:LYNETTE
Last Name:BETHE
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 1:14163 W WARREN CIR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-5925
Mailing Address - Country:US
Mailing Address - Phone:303-257-8900
Mailing Address - Fax:
Practice Address - Street 1:14163 W WARREN CIR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-5925
Practice Address - Country:US
Practice Address - Phone:303-257-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional