Provider Demographics
NPI:1831512268
Name:SUTTON, BETHANY ALICE MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ALICE MARIE
Last Name:SUTTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-4224
Mailing Address - Country:US
Mailing Address - Phone:541-953-8249
Mailing Address - Fax:253-697-3730
Practice Address - Street 1:104 W MEEKER STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8901
Practice Address - Country:US
Practice Address - Phone:541-953-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2014-017A106H00000X
WAMG60607282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist