Healthcare Provider Details

I. General information

NPI: 1912515941
Provider Name (Legal Business Name): BETHANY LEE RUGAN LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2020
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W MISSION AVE STE 122
SPOKANE WA
99201-2345
US

IV. Provider business mailing address

2601 N BARKER RD TRLR 58
SPOKANE VALLEY WA
99027-9542
US

V. Phone/Fax

Practice location:
  • Phone: 509-842-0067
  • Fax:
Mailing address:
  • Phone: 509-558-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61081721
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: