Healthcare Provider Details

I. General information

NPI: 1972378404
Provider Name (Legal Business Name): DIANE SACKS MA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 47TH AVE SW
SEATTLE WA
98116-2108
US

IV. Provider business mailing address

2136 47TH AVE SW
SEATTLE WA
98116-2108
US

V. Phone/Fax

Practice location:
  • Phone: 206-932-4424
  • Fax:
Mailing address:
  • Phone: 206-932-4424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANE L SACKS
Title or Position: PROVIDER
Credential: MA, LMFT
Phone: 206-932-4424