Provider Demographics
NPI:1770862526
Name:HERIVEL, DIANNE M (LMFT)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:M
Last Name:HERIVEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4509 181ST PL SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98037-4620
Mailing Address - Country:US
Mailing Address - Phone:206-713-4884
Mailing Address - Fax:425-774-6328
Practice Address - Street 1:16825 48TH AVE W STE 408
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-6405
Practice Address - Country:US
Practice Address - Phone:206-713-4884
Practice Address - Fax:425-774-6328
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60143446101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2066403Medicaid