Provider Demographics
NPI:1356819346
Name:KAEHR, DIANE (MS, LMFTA, LMHCA)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KAEHR
Suffix:
Gender:F
Credentials:MS, LMFTA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4750
Mailing Address - Country:US
Mailing Address - Phone:260-484-4153
Mailing Address - Fax:260-484-2337
Practice Address - Street 1:1825 BEACON ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4750
Practice Address - Country:US
Practice Address - Phone:260-484-4153
Practice Address - Fax:260-484-2337
Is Sole Proprietor?:No
Enumeration Date:2018-11-07
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35002034A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health