Provider Demographics
NPI:1639209422
Name:PRATT, DIANNA LYNN (PSYD)
Entity type:Individual
Prefix:MS
First Name:DIANNA
Middle Name:LYNN
Last Name:PRATT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 GRATIOT BLVD
Mailing Address - Street 2:BLDG B., SUITE 4
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1145
Mailing Address - Country:US
Mailing Address - Phone:810-364-5800
Mailing Address - Fax:810-364-1200
Practice Address - Street 1:1600 GRATIOT BLVD
Practice Address - Street 2:BLDG B., SUITE 4
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1145
Practice Address - Country:US
Practice Address - Phone:810-364-5800
Practice Address - Fax:810-364-1200
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014401103TC0700X, 103TC2200X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily