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General NPI Number Information
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NPI Number | 1154524460
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Entity Type | Organization
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Legal Business Name | DOCTOR DIANE, PS
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 1412 SW 43RD ST STE 240
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 253-852-4699
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Fax | 844-848-1265
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Provider Business Mailing Address
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Address Line | 7306 SW 34TH AVE STE 1 #228
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City | AMARILLO
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State | TX
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Zip | 79121-1140
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Country | US
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Telephone | 253-852-4699
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Fax | 844-848-1265
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANE M ADAMS
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Credential | PH.D.
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Telephone | 253-852-4699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY2393
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 602507189
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License Number State | WA
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