Provider Demographics
NPI:1770622193
Name:MHOON, DIANE (MA, LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:MHOON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2918 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5772
Mailing Address - Country:US
Mailing Address - Phone:719-439-6300
Mailing Address - Fax:719-264-7618
Practice Address - Street 1:2918 AUSTIN BLUFFS PKWY
Practice Address - Street 2:200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5772
Practice Address - Country:US
Practice Address - Phone:719-439-6300
Practice Address - Fax:719-264-7618
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011207101YM0800X
WARC00054520101YM0800X
COLPC0011269101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health