MEDICARE: BETHANY BYLSMA M.A.C.P. LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60835726	WA

General Provider Information

NPI Number	:	1689037939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY BYLSMA M.A.C.P. LMHC

Provider Business Mailing Address
First Line	:	7900 E GREEN LAKE DR N STE 202
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4818
Country	:	US
Telephone Number	:	253-256-5131
Fax Number	:

Provider Business Practice Location Address
First Line	:	7900 E GREEN LAKE DR N STE 202
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-4818
Country	:	US
Telephone Number	:	253-256-5131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2016
Last Update Date	:	04/16/2020

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