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General NPI Number Information
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NPI Number | 1841583234
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Entity Type | Individual
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Provider Name | BETHANY LAURAL ANDERSON LCSW, RPT
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Gender | Female
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 11/30/2020
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Provider Practice Location Address
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Address Line | 1576 S 500 W STE 202
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City | WOODS CROSS
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State | UT
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Zip | 84010-7433
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Country | US
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Telephone | 801-406-9002
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Fax |
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Provider Business Mailing Address
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Address Line | 555 E 3RD AVE
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-2975
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Country | US
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Telephone | 602-550-4686
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8281717-3501
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License Number State | UT
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