Provider Demographics
NPI:1811068075
Name:BROWN, DIANE D (LPC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:DIANE
Other - Middle Name:D
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 W 15TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3640
Mailing Address - Country:US
Mailing Address - Phone:405-348-6054
Mailing Address - Fax:405-348-6180
Practice Address - Street 1:500 W 15TH ST STE 2
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3640
Practice Address - Country:US
Practice Address - Phone:405-348-6054
Practice Address - Fax:405-348-6180
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health