Provider Demographics
NPI:1104067057
Name:OTT, DIANE M (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:OTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 WASHINGTON PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-1434
Mailing Address - Country:US
Mailing Address - Phone:412-221-1091
Mailing Address - Fax:412-221-2939
Practice Address - Street 1:3117 WASHINGTON PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-1434
Practice Address - Country:US
Practice Address - Phone:412-221-1091
Practice Address - Fax:412-221-2939
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC004281OtherPA LICENSE