MEDICARE: DIANE C CRITCHLOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	61026176	WA

General Provider Information

NPI Number	:	1952972671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE C CRITCHLOW

Provider Business Mailing Address
First Line	:	1419 S KAHUNA DR
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-3243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1419 S KAHUNA DR
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99212-3243
Country	:	US
Telephone Number	:	509-990-4760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2021
Last Update Date	:	07/03/2021

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Directions to “ DIANE C CRITCHLOW ” Practice Location

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