Provider Demographics
NPI:1255414777
Name:HERSETH, DIANE FRIEDMAN (LPCMH)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:FRIEDMAN
Last Name:HERSETH
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:KAY
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 8TH AVE NW
Mailing Address - Street 2:SUITE 333
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2762
Mailing Address - Country:US
Mailing Address - Phone:605-225-3622
Mailing Address - Fax:605-229-2719
Practice Address - Street 1:405 8TH AVE NW
Practice Address - Street 2:SUITE 333
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2762
Practice Address - Country:US
Practice Address - Phone:605-225-3622
Practice Address - Fax:605-229-2719
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPCMH 2126101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6576040Medicaid