Provider Demographics
NPI:1578072211
Name:EHLY, DIANE CECILE (LCMHC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:CECILE
Last Name:EHLY
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:DIANNE
Other - Middle Name:A
Other - Last Name:TURENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1021
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05601-1021
Mailing Address - Country:US
Mailing Address - Phone:802-522-9816
Mailing Address - Fax:
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-522-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0129231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1031549Medicaid