Provider Demographics
NPI:1205058203
Name:BUSCARELLO, DIANE G (LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:G
Last Name:BUSCARELLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 ATCHISON AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2211
Mailing Address - Country:US
Mailing Address - Phone:719-661-3619
Mailing Address - Fax:
Practice Address - Street 1:127 N. COMMERCIAL ST.
Practice Address - Street 2:UNIT 212
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-8108
Practice Address - Country:US
Practice Address - Phone:719-661-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0263101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional