Healthcare Provider Details

I. General information

NPI: 1639461536
Provider Name (Legal Business Name): BETHANY ANDERSON MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 WYATT WAY NE STE 206
BAINBRIDGE ISLAND WA
98110-2873
US

IV. Provider business mailing address

271 WYATT WAY NE STE 206
BAINBRIDGE ISLAND WA
98110-2873
US

V. Phone/Fax

Practice location:
  • Phone: 206-780-7822
  • Fax: 206-780-7880
Mailing address:
  • Phone: 206-780-7822
  • Fax: 206-780-7880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLF60370018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: