Provider Demographics
NPI:1740536457
Name:VALDESPINO, DIANE MELANIE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MELANIE
Last Name:VALDESPINO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18036 SE 240TH PL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98042-4810
Mailing Address - Country:US
Mailing Address - Phone:253-294-0617
Mailing Address - Fax:
Practice Address - Street 1:3627 152ND ST NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-8944
Practice Address - Country:US
Practice Address - Phone:253-294-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60502604101YM0800X
WALH61132618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2039243Medicaid