Provider Demographics
NPI:1427443506
Name:MAYTAS, DIANE J (LPCC, ATR, CHT)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:J
Last Name:MAYTAS
Suffix:
Gender:F
Credentials:LPCC, ATR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 CURRIE HALL PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4312
Mailing Address - Country:US
Mailing Address - Phone:330-673-5812
Mailing Address - Fax:
Practice Address - Street 1:190 CURRIE HALL PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4312
Practice Address - Country:US
Practice Address - Phone:330-673-5812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0600184101YP2500X
OHC 0600184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional