Provider Demographics
NPI:1154524460
Name:DOCTOR DIANE, PS
Entity type:Organization
Organization Name:DOCTOR DIANE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-852-4699
Mailing Address - Street 1:7306 SW 34TH AVE
Mailing Address - Street 2:STE 1 #228
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121-1140
Mailing Address - Country:US
Mailing Address - Phone:253-852-4699
Mailing Address - Fax:844-848-1265
Practice Address - Street 1:1412 SW 43RD ST STE 240
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4803
Practice Address - Country:US
Practice Address - Phone:253-852-4699
Practice Address - Fax:844-848-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602507189103T00000X
WAPY2393103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty