Provider Demographics
NPI:1558439521
Name:DAVIS, DIANE F (LPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:F
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8166
Mailing Address - Country:US
Mailing Address - Phone:417-753-3363
Mailing Address - Fax:
Practice Address - Street 1:1722 S GLENSTONE AVE STE TT
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1517
Practice Address - Country:US
Practice Address - Phone:417-881-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional