Provider Demographics
NPI:1851073191
Name:VOGELZANG, DIANE MEYER (MA, LCPCI)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MEYER
Last Name:VOGELZANG
Suffix:
Gender:F
Credentials:MA, LCPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11382 WINTER COTTAGE PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1704
Mailing Address - Country:US
Mailing Address - Phone:702-228-4403
Mailing Address - Fax:
Practice Address - Street 1:3243 E WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3185
Practice Address - Country:US
Practice Address - Phone:702-434-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional