Healthcare Provider Details

I. General information

NPI: 1568531598
Provider Name (Legal Business Name): BETH J. DECARTERET LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BETH J. HELM LMP

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 MAIN ST.
BUCKLEY WA
98321
US

IV. Provider business mailing address

P.O. BOX 1671
BUCKLEY WA
98321
US

V. Phone/Fax

Practice location:
  • Phone: 253-370-6423
  • Fax: 360-829-5237
Mailing address:
  • Phone: 253-370-6423
  • Fax: 360-829-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00013437
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: