Provider Demographics
NPI:1700279700
Name:DIANE J. MAYTAS
Entity Type:Organization
Organization Name:DIANE J. MAYTAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL CLINICAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYTAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:330-205-3457
Mailing Address - Street 1:582 BARRINGTON PL W
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-6768
Mailing Address - Country:US
Mailing Address - Phone:330-205-3457
Mailing Address - Fax:
Practice Address - Street 1:582 BARRINGTON PL W
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-6768
Practice Address - Country:US
Practice Address - Phone:330-205-3457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC 0600184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty