Provider Demographics
NPI:1780712877
Name:DIESTE, SHAKTI (MA LMHC)
Entity type:Individual
Prefix:MS
First Name:SHAKTI
Middle Name:
Last Name:DIESTE
Suffix:
Gender:F
Credentials:MA LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1879 25TH STREET
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-7033
Mailing Address - Country:US
Mailing Address - Phone:360-379-0719
Mailing Address - Fax:360-379-0333
Practice Address - Street 1:1879 25TH STREET
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-7033
Practice Address - Country:US
Practice Address - Phone:360-379-0333
Practice Address - Fax:360-379-0333
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00003951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health