Provider Demographics
NPI:1457860538
Name:SUPPES, BETHANY (LMFT)
Entity type:Individual
Prefix:DR
First Name:BETHANY
Middle Name:
Last Name:SUPPES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 E HOLLAND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-5016
Mailing Address - Country:US
Mailing Address - Phone:509-850-0844
Mailing Address - Fax:855-717-3850
Practice Address - Street 1:775 E HOLLAND AVE STE 102
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-5016
Practice Address - Country:US
Practice Address - Phone:509-850-0844
Practice Address - Fax:855-717-3850
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4961667106H00000X
WALF60950442106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist