1134402639 NPI number — BETHANY J HENDRICKSON MA, LMHC, MHP

Table of content: (NPI 1144236308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134402639 NPI number — BETHANY J HENDRICKSON MA, LMHC, MHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENDRICKSON
Provider First Name:
BETHANY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC, MHP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETERSEN
Provider Other First Name:
BETHANY
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134402639
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11320 ROOSEVELT WAY NE
Provider Second Line Business Mailing Address:
C/O NORTHWEST FAMILY LIFE
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98125-6228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-820-2557
Provider Business Mailing Address Fax Number:
206-363-9639

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11320 ROOSEVELT WAY NE
Provider Second Line Business Practice Location Address:
C/O NORTHWEST FAMILY LIFE
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-6228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-820-2557
Provider Business Practice Location Address Fax Number:
206-363-9639
Provider Enumeration Date:
09/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH60511822 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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