Provider Demographics
NPI:1114228699
Name:RELLER, DIANE KAY (MS, LMFT, LADC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:KAY
Last Name:RELLER
Suffix:
Gender:F
Credentials:MS, LMFT, LADC
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:KAY
Other - Last Name:SEEGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT LADC
Mailing Address - Street 1:1406 6TH AVE N
Mailing Address - Street 2:ST CLOUD HOSPITAL
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1900
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7715
Practice Address - Street 1:1406 6TH AVE N
Practice Address - Street 2:ST CLOUD HOSPITAL
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1900
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-656-7715
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300163101Y00000X, 101YA0400X
MN2067106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)