Provider Demographics
NPI:1386307908
Name:BEBICH, COLLEEN MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:MARIE
Last Name:BEBICH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 BRIDLEPATH DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8867
Mailing Address - Country:US
Mailing Address - Phone:206-356-5705
Mailing Address - Fax:
Practice Address - Street 1:3208 50TH STREET CT STE 105C
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5507
Practice Address - Country:US
Practice Address - Phone:253-376-7806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA611234041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical