# DIVERSE BEHAVIORAL HEALTH CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073391041
- **Authorized official:** DARA BERNAL (OWNER)
- **Authorized official phone:** (360) 533-3216

## Contact information

- **Practice address:** 3516 7TH AVE SW STE A, OLYMPIA, WA 98502-5011
- **Practice address phone:** (360) 533-3216
- **Mailing address:** PO BOX 5482, LACEY, WA 98509-5482
- **Mailing address phone:** (360) 533-3216

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2023
- **Last updated:** 09/20/2023