Healthcare Provider Details

I. General information

NPI: 1619020047
Provider Name (Legal Business Name): REBECCA LYNN BEUTLER ED.D., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 03/02/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 112TH AVE E STE A
PUYALLUP WA
98372-5903
US

IV. Provider business mailing address

5511 112TH AVE E STE A
PUYALLUP WA
98372-5903
US

V. Phone/Fax

Practice location:
  • Phone: 253-278-9292
  • Fax: 253-268-2021
Mailing address:
  • Phone: 253-278-9292
  • Fax: 253-268-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60083795
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00054134
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY60318110
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: