Provider Demographics
NPI:1598377988
Name:CLARKE, DIANA LYNN (LMHC, NCC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 WINTER WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5212
Mailing Address - Country:US
Mailing Address - Phone:317-795-8844
Mailing Address - Fax:
Practice Address - Street 1:758 WINTER WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5212
Practice Address - Country:US
Practice Address - Phone:317-795-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004816A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty