Provider Demographics
NPI:1992133151
Name:DIETCHMAN AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:DIETCHMAN AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DIETCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PSYCHOLOGIS
Authorized Official - Phone:816-716-3111
Mailing Address - Street 1:4016 S LYNN CT DR
Mailing Address - Street 2:STE. B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3360
Mailing Address - Country:US
Mailing Address - Phone:816-716-3111
Mailing Address - Fax:
Practice Address - Street 1:4016 S LYNN CT DR
Practice Address - Street 2:STE. B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3360
Practice Address - Country:US
Practice Address - Phone:816-716-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-28
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1464102L00000X
MO01720103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Multi-Specialty