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General NPI Number Information
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NPI Number | 1457860538
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Entity Type | Individual
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Provider Name | BETHANY SUPPES LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/21/2017
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 775 E HOLLAND AVE STE 102
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City | SPOKANE
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State | WA
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Zip | 99218-5016
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Country | US
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Telephone | 509-850-0844
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Fax | 855-717-3850
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Provider Business Mailing Address
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Address Line | 775 E HOLLAND AVE STE 102
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City | SPOKANE
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State | WA
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Zip | 99218-5016
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Country | US
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Telephone | 509-850-0844
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Fax | 855-717-3850
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 4961667
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF60950442
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License Number State | WA
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