Provider Demographics
NPI:1750599486
Name:MUSHABEN, DIANE COUSINO (LPCC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:COUSINO
Last Name:MUSHABEN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3629 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-1430
Mailing Address - Country:US
Mailing Address - Phone:859-581-8974
Mailing Address - Fax:859-581-9595
Practice Address - Street 1:3629 CHURCH ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1430
Practice Address - Country:US
Practice Address - Phone:859-581-8974
Practice Address - Fax:859-581-9595
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE4224101YP2500X
KYKY-930101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional