Provider Demographics
NPI:1447007067
Name:BRACKETT, DIANA CAROL
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:CAROL
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15718 97TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6703
Mailing Address - Country:US
Mailing Address - Phone:253-970-1236
Mailing Address - Fax:
Practice Address - Street 1:1701 13TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4707
Practice Address - Country:US
Practice Address - Phone:253-848-0880
Practice Address - Fax:253-848-9903
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor