Provider Demographics
NPI:1093927147
Name:TEMENOS COUNSELING SERVICES
Entity Type:Organization
Organization Name:TEMENOS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DIETZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:414-704-7370
Mailing Address - Street 1:7441 WEST GREENFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214
Mailing Address - Country:US
Mailing Address - Phone:707-443-3384
Mailing Address - Fax:707-443-3204
Practice Address - Street 1:7441 WEST GREENFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214
Practice Address - Country:US
Practice Address - Phone:707-443-3384
Practice Address - Fax:707-443-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1905101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42183300Medicaid