Basic Information
| Provider Information | |||||||||
| NPI: | 1174864052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLAPRETE | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.ED, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1984 BROWN RD | ||||||||
| Address2: | |||||||||
| City: | LENORE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 835415095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084319119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 212 RODEO DR | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | MOSCOW | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838439798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088825960 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2013 | ||||||||
| LastUpdateDate: | 03/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-5059 | ID | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.