Provider Demographics
NPI:1225465644
Name:NEAL, DIANE LISA (MS , LPCC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LISA
Last Name:NEAL
Suffix:
Gender:F
Credentials:MS , LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29607 139TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-3688
Mailing Address - Country:US
Mailing Address - Phone:763-203-5550
Mailing Address - Fax:
Practice Address - Street 1:450 JEFFERSON BLVD STE 4
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-1902
Practice Address - Country:US
Practice Address - Phone:763-631-6325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00690101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health