Provider Demographics
NPI:1154786747
Name:BALKUS, BETHANY (PSY D, LP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:BALKUS
Suffix:
Gender:F
Credentials:PSY D, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19803 N CREEK PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5014
Mailing Address - Country:US
Mailing Address - Phone:360-990-4699
Mailing Address - Fax:
Practice Address - Street 1:19803 N CREEK PKWY STE 205
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5014
Practice Address - Country:US
Practice Address - Phone:360-990-4699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-23
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60422467103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist