Provider Demographics
NPI:1669612644
Name:O'BRIEN, DIANE M (LPC)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:O'BRIEN
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 1:2605 W DOVE VALLEY RD APT 115
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-5202
Mailing Address - Country:US
Mailing Address - Phone:910-712-6824
Mailing Address - Fax:
Practice Address - Street 1:2605 W DOVE VALLEY RD APT 115
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-5202
Practice Address - Country:US
Practice Address - Phone:910-712-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20388101YP2500X
GALPC004915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional