Provider Demographics
NPI:1982111910
Name:GIL MURILLO, DIANA (RBT, CBT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:GIL MURILLO
Suffix:
Gender:F
Credentials:RBT, CBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 7TH ST SE APT T204
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-1124
Mailing Address - Country:US
Mailing Address - Phone:602-910-9985
Mailing Address - Fax:
Practice Address - Street 1:2313 SW 339TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-7730
Practice Address - Country:US
Practice Address - Phone:602-910-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB60772022106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician