Healthcare Provider Details

I. General information

NPI: 1265836910
Provider Name (Legal Business Name): BETHANY BERITH BICKEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 COMMERCIAL ST SE STE 201
SALEM OR
97301-3463
US

IV. Provider business mailing address

PO BOX 170
SUTHERLIN OR
97479-0170
US

V. Phone/Fax

Practice location:
  • Phone: 971-388-4659
  • Fax:
Mailing address:
  • Phone: 971-388-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA4271
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL8081
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: