MEDICARE: MS. DIANNE R. STITZER M.S., L.M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TS0200X	School Psychologist
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1659400711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANNE R. STITZER M.S., L.M.F.T.

Provider Business Mailing Address
First Line	:	3212 INDIANA AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-1703
Country	:	US
Telephone Number	:	260-456-8517
Fax Number	:	260-456-8517

Provider Business Practice Location Address
First Line	:	1410 LOWER HUNTINGTON RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46819-1359
Country	:	US
Telephone Number	:	260-478-7320
Fax Number	:	260-478-7408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/11/2025

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