=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982596227
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DYLAN HIGGINBOTHAM MA OF COUNSELING
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2025
-----------------------------------------------------
Last Update Date | 07/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2366 EASTLAKE AVE E STE 402
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98102-3394
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-766-4068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9012 8TH AVE NW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98117-3201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-766-4068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MC61689086
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------