Provider Demographics
NPI:1447916382
Name:HALVORSEN, BETH ANN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:ANN
Last Name:HALVORSEN
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 1:1803 RIVER WALK LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-2122
Mailing Address - Country:US
Mailing Address - Phone:402-817-8417
Mailing Address - Fax:
Practice Address - Street 1:1803 RIVER WALK LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-2122
Practice Address - Country:US
Practice Address - Phone:402-817-8417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61085871106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty