Provider Demographics
NPI:1285331744
Name:RIDGE, BETTI LUE (LMHC)
Entity type:Individual
Prefix:
First Name:BETTI
Middle Name:LUE
Last Name:RIDGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13262 NW HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-7610
Mailing Address - Country:US
Mailing Address - Phone:360-620-0375
Mailing Address - Fax:
Practice Address - Street 1:13262 NW HOLLY RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-7610
Practice Address - Country:US
Practice Address - Phone:360-620-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60172440101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health