Healthcare Provider Details

I. General information

NPI: 1578019691
Provider Name (Legal Business Name): VERONICA ITZEL DIAZ LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 221ST PL SE
ISSAQUAH WA
98027-8917
US

IV. Provider business mailing address

3808 S ANGELINE ST
SEATTLE WA
98118-1712
US

V. Phone/Fax

Practice location:
  • Phone: 425-391-0887
  • Fax: 425-391-7014
Mailing address:
  • Phone: 206-461-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61138067
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: