Provider Demographics
NPI:1245396738
Name:CAILLOUET, DIANA GAIL (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:GAIL
Last Name:CAILLOUET
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 SCOTTSVILLE RD #22
Mailing Address - Street 2:22
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-6509
Mailing Address - Country:US
Mailing Address - Phone:270-782-6121
Mailing Address - Fax:270-842-2734
Practice Address - Street 1:2530 SCOTTSVILLE RD
Practice Address - Street 2:22
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-6509
Practice Address - Country:US
Practice Address - Phone:270-782-6121
Practice Address - Fax:270-842-2734
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0060106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100344610Medicaid
KYKY-0060OtherLMFT LICENSURE NUMBER