Provider Demographics
NPI:1083053300
Name:ZIETZ, DERREK DANIAL (MS, LMHCA, NCC)
Entity Type:Individual
Prefix:MR
First Name:DERREK
Middle Name:DANIAL
Last Name:ZIETZ
Suffix:
Gender:M
Credentials:MS, LMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 BOREN AVE
Mailing Address - Street 2:SUITE 701
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3595
Mailing Address - Country:US
Mailing Address - Phone:206-458-2556
Mailing Address - Fax:206-456-5192
Practice Address - Street 1:901 BOREN AVE
Practice Address - Street 2:SUITE 701
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3595
Practice Address - Country:US
Practice Address - Phone:206-458-2556
Practice Address - Fax:206-456-5192
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60330693101YM0800X
KS2414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health