Provider Demographics
NPI:1396072351
Name:WISEMAN, DIANE CASSODY
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:CASSODY
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:DIANE
Other - Last Name:CASSODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:8810 S YALE AVE STE P
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-3551
Mailing Address - Country:US
Mailing Address - Phone:918-855-1435
Mailing Address - Fax:918-626-1388
Practice Address - Street 1:8810 S YALE AVE STE P
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-3551
Practice Address - Country:US
Practice Address - Phone:918-855-1435
Practice Address - Fax:918-626-1388
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3532101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional