Provider Demographics
NPI:1194175000
Name:TUBBS, BETHANY NICOLE
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:NICOLE
Last Name:TUBBS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5306 BALLARD AVE NW STE 319
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4366
Mailing Address - Country:US
Mailing Address - Phone:415-579-3223
Mailing Address - Fax:
Practice Address - Street 1:5306 BALLARD AVE NW STE 319
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107
Practice Address - Country:US
Practice Address - Phone:415-579-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60900990106H00000X
WAMG60675593106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist