Provider Demographics
NPI:1376988097
Name:SQUIRE, DEBRAH LYN
Entity Type:Individual
Prefix:MRS
First Name:DEBRAH
Middle Name:LYN
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DEBBIE
Other - Middle Name:LYN
Other - Last Name:SQUIRE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AAC
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:14216 NE 21ST ST
Practice Address - Street 2:NORTHCREEK
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3720
Practice Address - Country:US
Practice Address - Phone:425-653-4900
Practice Address - Fax:425-653-4910
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60321774101Y00000X, 101YM0800X, 172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker