Provider Demographics
NPI:1568190387
Name:COURTNEY, DIANE LYNN (PLPC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64468-1614
Mailing Address - Country:US
Mailing Address - Phone:660-562-3000
Mailing Address - Fax:660-562-3000
Practice Address - Street 1:423 N MARKET ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-1614
Practice Address - Country:US
Practice Address - Phone:660-562-3000
Practice Address - Fax:660-562-3002
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022030850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health