Healthcare Provider Details

I. General information

NPI: 1386307908
Provider Name (Legal Business Name): COLLEEN MARIE BEBICH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 50TH STREET CT STE 105C
GIG HARBOR WA
98335-5507
US

IV. Provider business mailing address

5014 BRIDLEPATH DR NW
GIG HARBOR WA
98332-8867
US

V. Phone/Fax

Practice location:
  • Phone: 253-376-7806
  • Fax:
Mailing address:
  • Phone: 206-356-5705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61123404
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: