Provider Demographics
NPI:1124015177
Name:SEWELL, PATRICIA DIANE (PHD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DIANE
Last Name:SEWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 SW 171ST ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3268
Mailing Address - Country:US
Mailing Address - Phone:206-399-5942
Mailing Address - Fax:206-444-0585
Practice Address - Street 1:2809 SW 171ST ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3268
Practice Address - Country:US
Practice Address - Phone:206-399-5942
Practice Address - Fax:206-444-0585
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHP10001373101YM0800X
WARC00049754101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health