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General NPI Number Information
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NPI Number | 1932305901
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Entity Type | Individual
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Provider Name | DIANE LYNN PHILLIPS ED.D.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1353 YUKON HARBOR RD SE
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City | PORT ORCHARD
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State | WA
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Zip | 98366-8576
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Country | US
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Telephone | 360-871-5494
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Fax | 360-871-5499
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Provider Business Mailing Address
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Address Line | PO BOX 487 MANCHESTER 98353 1353 YUKON HARBOR SE
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City | PORT ORCHARD
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State | WA
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Zip | 98366
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Country | US
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Telephone | 360-871-5494
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Fax | 360-871-5499
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH00006197
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License Number State | WA
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