1417480609 NPI number — MRS. DIANE MARIE SABO MA, LMHC

Table of content: MRS. DIANE MARIE SABO MA, LMHC (NPI 1417480609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417480609 NPI number — MRS. DIANE MARIE SABO MA, LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SABO
Provider First Name:
DIANE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARSON
Provider Other First Name:
DIANE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417480609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2813
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-697-9101
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
843 6TH STREET
Provider Second Line Business Practice Location Address:
SUITE 220 AND 240
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-697-9101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LH60652618 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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