Provider Demographics
NPI:1801495080
Name:DEITZ, CORI (PHD)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:
Last Name:DEITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 124TH AVE NE UNIT 191
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1807
Mailing Address - Country:US
Mailing Address - Phone:925-529-1315
Mailing Address - Fax:
Practice Address - Street 1:1709 124TH AVE NE UNIT 191
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1807
Practice Address - Country:US
Practice Address - Phone:925-529-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty