Provider Demographics
NPI:1962133959
Name:KAFOURE, DIANA LYNN (LMHCA)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LYNN
Last Name:KAFOURE
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 W BRADFORD CT
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-8515
Mailing Address - Country:US
Mailing Address - Phone:317-620-1878
Mailing Address - Fax:
Practice Address - Street 1:4553 W BRADFORD CT
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8515
Practice Address - Country:US
Practice Address - Phone:317-620-1878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99111306A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health