Provider Demographics
NPI:1902296387
Name:MILLER, DIANNA LYNN (LCPC,CRADC,LMHC,LCAC)
Entity type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCPC,CRADC,LMHC,LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E CHICAGO AVE STE 30
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1756
Mailing Address - Country:US
Mailing Address - Phone:708-769-1374
Mailing Address - Fax:
Practice Address - Street 1:200 E CHICAGO AVE STE 30
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1756
Practice Address - Country:US
Practice Address - Phone:630-481-4101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL23238101YA0400X
IN87000115A101YA0400X
IN180009026101YM0800X
IN39002410A101YM0800X
IL180.009026101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health