Provider Demographics
NPI:1669561080
Name:PLEASANT, DIANE S (PSYD, LCPC, CADC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:S
Last Name:PLEASANT
Suffix:
Gender:F
Credentials:PSYD, LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E WOOD ST STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1431
Mailing Address - Country:US
Mailing Address - Phone:217-422-6908
Mailing Address - Fax:217-422-7103
Practice Address - Street 1:335 E WOOD ST STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523
Practice Address - Country:US
Practice Address - Phone:217-422-6908
Practice Address - Fax:217-422-7103
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005694103TC1900X, 101Y00000X, 101YM0800X, 103T00000X, 103TA0400X, 103TB0200X, 103TF0000X, 171M00000X, 101YP2500X
IL22217101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202415440001Medicaid