Provider Demographics
NPI:1598852394
Name:CHAMRAD, DIANA LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LYNN
Last Name:CHAMRAD
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:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-0292
Mailing Address - Country:US
Mailing Address - Phone:360-221-7892
Mailing Address - Fax:360-221-2515
Practice Address - Street 1:919 3RD ST
Practice Address - Street 2:#101
Practice Address - City:LANGLEY
Practice Address - State:WA
Practice Address - Zip Code:98260-9228
Practice Address - Country:US
Practice Address - Phone:360-221-7892
Practice Address - Fax:360-221-2515
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical