Provider Demographics
NPI:1659400711
Name:STITZER, DIANNE R (MS, LMFT)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:R
Last Name:STITZER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46807-1703
Mailing Address - Country:US
Mailing Address - Phone:260-456-8517
Mailing Address - Fax:260-456-8517
Practice Address - Street 1:1410 LOWER HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46819-1359
Practice Address - Country:US
Practice Address - Phone:260-478-7320
Practice Address - Fax:260-478-7408
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist