Provider Demographics
NPI:1114095155
Name:BROWN, ROXANNE DIRKS (LMHC)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:DIRKS
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:RAE
Other - Last Name:DIRKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:426 N MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371
Mailing Address - Country:US
Mailing Address - Phone:253-841-3297
Mailing Address - Fax:253-841-3341
Practice Address - Street 1:426 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371
Practice Address - Country:US
Practice Address - Phone:253-841-3297
Practice Address - Fax:253-841-3341
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004918101YM0800X
WAH20090174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered174400000XOther Service ProvidersSpecialist