Provider Demographics
NPI:1740522978
Name:DIETTE-NELSON, TERI ELLEN (MS, LMHCA)
Entity type:Individual
Prefix:MRS
First Name:TERI
Middle Name:ELLEN
Last Name:DIETTE-NELSON
Suffix:
Gender:F
Credentials:MS, LMHCA
Other - Prefix:MRS
Other - First Name:TERI
Other - Middle Name:ELLEN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LMHCA
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:2719 E MADISON ST STE 200
Practice Address - Street 2:SOUND MENTAL HEALTH
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4752
Practice Address - Country:US
Practice Address - Phone:206-302-2993
Practice Address - Fax:206-302-2610
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60339800101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor