Provider Demographics
NPI:1336291848
Name:SALEEBY, DIANE (LMHC, PH D)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:SALEEBY
Suffix:
Gender:F
Credentials:LMHC, PH D
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:TAVERNIER
Mailing Address - State:FL
Mailing Address - Zip Code:33070-0264
Mailing Address - Country:US
Mailing Address - Phone:305-852-8482
Mailing Address - Fax:
Practice Address - Street 1:91831 OVERSEAS HWY
Practice Address - Street 2:SUITE A
Practice Address - City:TAVERNIER
Practice Address - State:FL
Practice Address - Zip Code:33070-2647
Practice Address - Country:US
Practice Address - Phone:305-852-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 3947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health