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NPI Code Detail

MEDICARE: BETTE R. JORAM PH. D.

MEDICARE: BETTE R. JORAM PH. D.
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 CounselorLH00006245WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1LH00006245OTHERWALICENSED MENTAL HEALTH CO

General Provider Information

NPI Number : 1790807386
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTE R. JORAM PH. D.
Provider Business Mailing Address
First Line : 4420 23RD AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98106-1312
Country : US
Telephone Number : 206-937-6831
Fax Number : 206-937-6831
Provider Business Practice Location Address
First Line : 4420 23RD AVE SW
Second Line :
City : SEATTLE
State : WA
Zip : 98106-1312
Country : US
Telephone Number : 206-937-6831
Fax Number : 206-937-6831
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2007
Last Update Date : 01/17/2014

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