Healthcare Provider Details

I. General information

NPI: 1366354854
Provider Name (Legal Business Name): JENNIFER DIEHL MC, LMHCA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7059 PRISM ST SE
LACEY WA
98513-5160
US

IV. Provider business mailing address

7059 PRISM ST SE
LACEY WA
98513-5160
US

V. Phone/Fax

Practice location:
  • Phone: 520-236-5222
  • Fax:
Mailing address:
  • Phone: 520-236-5222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70048643
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: