NPIMap

Organization Active NPI

Diana Chan Counseling PLLC

  • Clinical Social Worker
  • Bainbridge Island, WA
National Provider Identifier
1679967186
Registry record updated Jul 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LW60193264 Issued in WA
Legal business name
DIANA CHAN COUNSELING PLLC
Practice address
793 Ericksen Ave NE Ste 123
Bainbridge Island, WA 98110-1877
Phone
(206) 207-5375
Fax
(206) 338-9906
NPI assigned
Mar 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wai Wun Diana Chan, MSW, LICSWNPI 1952552309
Title
Therapist
Phone
(206) 321-3203

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X LW60193264 WA
Professional CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YP2500X LW60193264 WA
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X LW60193264 WA
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X LW60193264 WA Primary

Addresses

Primary practice location

793 Ericksen Ave NE Ste 123
Bainbridge Island, WA 98110-1877

Mailing address

793 Ericksen Ave NE Ste 123
Bainbridge Island, WA 98110-1877
Phone (206) 321-3203

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150811004133 WA Part B Supplier - Clinic/Group Practice 8628383395 Receives reassigned benefits from 1 practitioner
Practice locations: Bainbridge Island, WA

National Provider Directory

National Provider Directory

Locations

755 Winslow Way E
Ste 103
Bainbridge Island, WA 98110
Phone (206) 207-5375

345 Knechtel Way NE
Ste 109
Bainbridge Island, WA 98110
Phone (206) 321-3203

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690416000000",
    "number": "1679967186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 ERICKSEN AVE NE STE 123",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101877",
            "telephone_number": "206-321-3203",
            "fax_number": "360-698-8950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "793 ERICKSEN AVE NE STE 123",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981101877",
            "telephone_number": "206-207-5375",
            "fax_number": "206-338-9906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANA CHAN COUNSELING PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-23",
        "last_updated": "2023-07-27",
        "certification_date": "2023-07-27",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "WAI WUN DIANA",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "206-321-3203",
        "authorized_official_credential": "MSW, LICSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "LW60193264",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "WA",
            "license": "LW60193264",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "WA",
            "license": "LW60193264",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60193264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bainbridge Island, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.