Healthcare Provider Details

I. General information

NPI: 1528114287
Provider Name (Legal Business Name): DIANA V TRAXLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/31/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 OLD HWY 99 SOUTH ROAD
MT VERNON WA
98273
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-542-8810
  • Fax: 206-766-6993
Mailing address:
  • Phone: 206-764-0112
  • Fax: 206-764-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60451793
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: