Individual
DIANE MUNDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1101 BROADWAY ST, VANCOUVER, WA 98660-3268
(360) 487-6319
Mailing address
1101 BROADWAY ST, VANCOUVER, WA 98660-3268
(360) 487-6319
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
L2490
OR
101YM0800X
Mental Health Counselor
Primary
LW60104168
WA
Other
Enumeration date
11/16/2006
Last updated
11/16/2021
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