Provider Demographics
NPI:1417331075
Name:CHEW, DIANE (PSYD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CHEW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 CENTENNIAL BLVD # 1006
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3335
Mailing Address - Country:US
Mailing Address - Phone:719-551-9226
Mailing Address - Fax:844-392-0874
Practice Address - Street 1:4520 CENTENNIAL BLVD # 1006
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3335
Practice Address - Country:US
Practice Address - Phone:719-551-9226
Practice Address - Fax:844-392-0874
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY0004423103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist