MEDICARE: BETHANY ANDERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1013643170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY ANDERSON

Provider Business Mailing Address
First Line	:	118E 8TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362
Country	:	US
Telephone Number	:	360-457-0431
Fax Number	:	360-457-0493

Provider Business Practice Location Address
First Line	:	118E 8TH ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-2489
Country	:	US
Telephone Number	:	360-452-5847
Fax Number	:	360-457-0493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2022
Last Update Date	:	06/26/2023

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Directions to “ BETHANY ANDERSON ” Practice Location

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