MEDICARE: MRS. NICHOLE BEDORE LCPC, LMHC

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	180010852	IL
2	101YP2500X	Professional Counselor	180010852	IL
3	101YM0800X	Mental Health Counselor	LH60801971	WA

General Provider Information

NPI Number	:	1952839862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICHOLE BEDORE LCPC, LMHC

Provider Business Mailing Address
First Line	:	10011 148TH STREET CT E
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98375-6523
Country	:	US
Telephone Number	:	773-516-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	4730 UNIVERSITY WAY NE STE 1042019
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4424
Country	:	US
Telephone Number	:	773-516-1789
Fax Number	:

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

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	10/30/2018

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