Healthcare Provider Details

I. General information

NPI: 1124015177
Provider Name (Legal Business Name): PATRICIA DIANE SEWELL PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 SW 171ST ST
BURIEN WA
98166-3268
US

IV. Provider business mailing address

2809 SW 171ST ST
BURIEN WA
98166-3268
US

V. Phone/Fax

Practice location:
  • Phone: 206-399-5942
  • Fax: 206-444-0585
Mailing address:
  • Phone: 206-399-5942
  • Fax: 206-444-0585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberHP10001373
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00049754
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: