Provider Demographics
NPI:1568084127
Name:DOBIER, DIANA BROOK (PSYD LCP)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:BROOK
Last Name:DOBIER
Suffix:
Gender:F
Credentials:PSYD LCP
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:BROOK
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD LCP
Mailing Address - Street 1:6482 LAKESHORE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-4707
Mailing Address - Country:US
Mailing Address - Phone:217-779-5506
Mailing Address - Fax:
Practice Address - Street 1:210 S RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-3828
Practice Address - Country:US
Practice Address - Phone:217-779-5506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-17
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005726103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist