Provider Demographics
NPI:1669528063
Name:GROB, DIANNE (LMHC)
Entity type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:
Last Name:GROB
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5107 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-1520
Mailing Address - Country:US
Mailing Address - Phone:206-545-1440
Mailing Address - Fax:206-729-6313
Practice Address - Street 1:823 NE 65TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5539
Practice Address - Country:US
Practice Address - Phone:206-545-1440
Practice Address - Fax:206-729-6313
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health