Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 5052 | CO |
Y | 101YP2500X | Professional Counselor | 3813 | CO |
NPI | 1003869959 |
---|---|
Provider Name | Mrs. Diane Jennette Strouse |
First Address | Centennial, CO 80112-6820 |
Second Address | Centennial, CO 80112-6820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 20/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3813 | LICENSED PROFESSIONAL COU (01) | CO |