Provider Demographics
NPI:1386677987
Name:DUTY, DIANE SCOTT (PCC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:SCOTT
Last Name:DUTY
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4803
Mailing Address - Country:US
Mailing Address - Phone:419-535-1901
Mailing Address - Fax:419-537-1922
Practice Address - Street 1:4159 HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4803
Practice Address - Country:US
Practice Address - Phone:419-535-1901
Practice Address - Fax:419-537-1922
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0002311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPS9278441Medicare ID - Type Unspecified