Provider Demographics
NPI:1558974030
Name:DIETZ, TAYLOR MICHELLE (LMHCA)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:MICHELLE
Last Name:DIETZ
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4418 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3528
Mailing Address - Country:US
Mailing Address - Phone:812-830-8367
Mailing Address - Fax:
Practice Address - Street 1:530 BENTEE WES CT
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715
Practice Address - Country:US
Practice Address - Phone:812-401-1836
Practice Address - Fax:812-401-8013
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99100095A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health