Provider Demographics
NPI:1386495349
Name:DIANE DAVIS COUNSELING LLC
Entity type:Organization
Organization Name:DIANE DAVIS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PLPC
Authorized Official - Phone:314-252-8434
Mailing Address - Street 1:3 THE PINES CT STE B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6081
Mailing Address - Country:US
Mailing Address - Phone:314-252-8434
Mailing Address - Fax:
Practice Address - Street 1:3 THE PINES CT STE B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6081
Practice Address - Country:US
Practice Address - Phone:314-252-8434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)