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NPI Code Detail

MEDICARE: BECKIE LAVERN WISDOM

MEDICARE:   BECKIE LAVERN WISDOM
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
1101YM0800XMental Health Counselor
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1255620092
Entity Type Code : Individual
Provider Name (Legal Business Name) : BECKIE LAVERN WISDOM
Provider Business Mailing Address
First Line : 600 LAKEWAY DR STE 100
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-5236
Country : US
Telephone Number : 503-238-0769
Fax Number : 503-552-6208
Provider Business Practice Location Address
First Line : 600 LAKEWAY DR STE 100
Second Line :
City : BELLINGHAM
State : WA
Zip : 98225-5236
Country : US
Telephone Number : 503-238-0769
Fax Number : 503-552-6208
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2011
Last Update Date : 05/26/2022

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Directions to “ BECKIE LAVERN WISDOM ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.