Provider Demographics
NPI:1760767628
Name:SPENGLER, DIANE HEALD (MA, MFTA)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:HEALD
Last Name:SPENGLER
Suffix:
Gender:F
Credentials:MA, MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 ERICKSEN AVE NE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-1886
Mailing Address - Country:US
Mailing Address - Phone:206-842-4835
Mailing Address - Fax:
Practice Address - Street 1:385 ERICKSEN AVE NE
Practice Address - Street 2:SUITE 121
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-1886
Practice Address - Country:US
Practice Address - Phone:206-842-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG601603385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional