Provider Demographics
NPI:1851683502
Name:DIETZ, DENISE JANELL (EDD, MFT, NCC)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:JANELL
Last Name:DIETZ
Suffix:
Gender:F
Credentials:EDD, MFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 W CANYON LAKES DR
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-2760
Mailing Address - Country:US
Mailing Address - Phone:509-205-5324
Mailing Address - Fax:
Practice Address - Street 1:3506 W CANYON LAKES DR
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-2760
Practice Address - Country:US
Practice Address - Phone:509-205-5324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0232101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health