Provider Demographics
NPI:1699856997
Name:HEYNEN, DIANNE S (MS, QMHP, LPC-MH)
Entity Type:Individual
Prefix:MS
First Name:DIANNE
Middle Name:S
Last Name:HEYNEN
Suffix:
Gender:F
Credentials:MS, QMHP, LPC-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 S SPENCER BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4653
Mailing Address - Country:US
Mailing Address - Phone:605-360-2613
Mailing Address - Fax:605-339-0710
Practice Address - Street 1:2701 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4744
Practice Address - Country:US
Practice Address - Phone:605-360-2613
Practice Address - Fax:605-339-0710
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH2048101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
15428OtherHEALTH PARTNERS
15428OtherVALUE OPTIONS
SD49974OtherBCBS
MN034T7OtherBCBS
SD22057OtherSIOUX VALLEY HEALTH
39026OtherWAUSAU BENEFITS
50374OtherTRICARE PRIME REMOTE
SD65755Medicaid
SD9212453OtherDAKOTACARE
62413OtherUNITED BEHAVIORAL HEALTH
87726OtherUNITED BEHAVIORAL HEALTH
12345OtherCIGNA HEALTHCARE
IA49974OtherBCBS