Provider Demographics
NPI:1912515941
Name:RUGAN, BETHANY LEE (LMHCA)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LEE
Last Name:RUGAN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 N BARKER RD TRLR 58
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99027-9542
Mailing Address - Country:US
Mailing Address - Phone:509-558-0531
Mailing Address - Fax:
Practice Address - Street 1:222 W MISSION AVE STE 122
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2345
Practice Address - Country:US
Practice Address - Phone:509-842-0067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61081721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health