Provider Demographics
NPI:1548368285
Name:CRAFT, DIANE (MA LPC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:CRAFT
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:PO BOX 1612
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-1612
Mailing Address - Country:US
Mailing Address - Phone:719-440-7486
Mailing Address - Fax:719-634-2563
Practice Address - Street 1:244 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9173
Practice Address - Country:US
Practice Address - Phone:719-440-7486
Practice Address - Fax:719-634-2563
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health