Provider Demographics
NPI:1336306745
Name:FOLLINGSTAD, DIANE RUTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:RUTH
Last Name:FOLLINGSTAD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:245 FOUNTAIN COURT PSYCHIATRY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1810
Mailing Address - Country:US
Mailing Address - Phone:859-218-2610
Mailing Address - Fax:859-323-4848
Practice Address - Street 1:245 FOUNTAIN COURT PSYCHIATRY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1810
Practice Address - Country:US
Practice Address - Phone:859-218-2610
Practice Address - Fax:859-323-4848
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC209103TC0700X
NC3345103TC0700X
KY129922103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical