=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194991661
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETHLYN LORENE WRIGHT LOVING MSW, LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2008
-----------------------------------------------------
Last Update Date | 11/08/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11918 246TH ST NE
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-501-8894
-----------------------------------------------------
Fax | 360-474-1948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11918 246TH ST NE
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98223-8129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-501-8894
-----------------------------------------------------
Fax | 360-474-1948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW00005389
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------