Provider Demographics
NPI:1700095312
Name:BEERS, DIANE ANNETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ANNETTE
Last Name:BEERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-6607
Mailing Address - Country:US
Mailing Address - Phone:651-442-3785
Mailing Address - Fax:651-426-9250
Practice Address - Street 1:1967 GARDEN LN
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-6607
Practice Address - Country:US
Practice Address - Phone:651-442-3785
Practice Address - Fax:651-426-9250
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1275106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist