Provider Demographics
NPI:1538926027
Name:THOMAS, DIANE MARIE (PSYD, LCPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PSYD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20844 W BANGOR CT
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7368
Mailing Address - Country:US
Mailing Address - Phone:815-474-4066
Mailing Address - Fax:
Practice Address - Street 1:28W141 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1953
Practice Address - Country:US
Practice Address - Phone:630-668-9696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional