Provider Demographics
NPI:1255463386
Name:BLANKENHEIM, BETHANY (LPC, CACII)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:
Last Name:BLANKENHEIM
Suffix:
Gender:F
Credentials:LPC, CACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 DEPOT HILL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-6724
Mailing Address - Country:US
Mailing Address - Phone:720-232-2303
Mailing Address - Fax:720-358-0846
Practice Address - Street 1:1008 DEPOT HILL RD STE 200
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6724
Practice Address - Country:US
Practice Address - Phone:720-232-2303
Practice Address - Fax:720-358-0846
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6920101YA0400X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)