Healthcare Provider Details

I. General information

NPI: 1205971587
Provider Name (Legal Business Name): DIANE CORREA LH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 S PINE ST STE 301
TACOMA WA
98409-7264
US

IV. Provider business mailing address

PO BOX 34584
SEATTLE WA
98124-1584
US

V. Phone/Fax

Practice location:
  • Phone: 253-476-6500
  • Fax: 253-476-6547
Mailing address:
  • Phone: 509-241-7349
  • Fax: 509-241-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLH00005452
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: