Basic Information
| Provider Information | |||||||||
| NPI: | 1740522978 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIETTE-NELSON | ||||||||
| FirstName: | TERI | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS, LMHCA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NELSON | ||||||||
| OtherFirstName: | TERI | ||||||||
| OtherMiddleName: | ELLEN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MS, LMHCA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1600 E OLIVE ST | ||||||||
| Address2: | SOUND MENTAL HEALTH | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022200 | ||||||||
| FaxNumber: | 2063022210 | ||||||||
| Practice Location | |||||||||
| Address1: | 2719 E MADISON ST STE 200 | ||||||||
| Address2: | SOUND MENTAL HEALTH | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981124752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063022993 | ||||||||
| FaxNumber: | 2063022610 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2013 | ||||||||
| LastUpdateDate: | 03/26/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | MC60339800 | WA | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | MC60339800 | WA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.