Provider Demographics
NPI:1588993992
Name:PENCE, DIANE MENKE (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MENKE
Last Name:PENCE
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 PINE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8785
Mailing Address - Country:US
Mailing Address - Phone:217-549-9292
Mailing Address - Fax:
Practice Address - Street 1:2536 S OLD HIGHWAY 94
Practice Address - Street 2:SUITE 234
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-5612
Practice Address - Country:US
Practice Address - Phone:636-896-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002125101YM0800X
COLPC.0012588101YM0800X
MO2016031492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health