Provider Demographics
NPI:1073793485
Name:WHITTEMORE ANDERSON, DIANNE MAY (EDD LPC)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:MAY
Last Name:WHITTEMORE ANDERSON
Suffix:
Gender:F
Credentials:EDD LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1634
Mailing Address - Street 2:
Mailing Address - City:PAONIA
Mailing Address - State:CO
Mailing Address - Zip Code:81428
Mailing Address - Country:US
Mailing Address - Phone:970-527-3027
Mailing Address - Fax:970-527-3027
Practice Address - Street 1:211 GRAND AVE
Practice Address - Street 2:
Practice Address - City:PAONIA
Practice Address - State:CO
Practice Address - Zip Code:81428
Practice Address - Country:US
Practice Address - Phone:970-527-3027
Practice Address - Fax:970-527-3027
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2366103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO337245Medicaid
CO841439569002OtherROCKY MTN HEALTH PLANS