Provider Demographics
NPI:1477576650
Name:DIEMER, RAEKO LEE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:RAEKO
Middle Name:LEE
Last Name:DIEMER
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 1:210 ANTLER DR
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172
Mailing Address - Country:US
Mailing Address - Phone:502-876-6106
Mailing Address - Fax:502-470-5721
Practice Address - Street 1:210 ANTLER DR
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-9775
Practice Address - Country:US
Practice Address - Phone:502-876-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0477106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist