Healthcare Provider Details

I. General information

NPI: 1669561080
Provider Name (Legal Business Name): DIANE S PLEASANT PSYD, LCPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E WOOD ST STE B
DECATUR IL
62523
US

IV. Provider business mailing address

335 E WOOD ST STE B
DECATUR IL
62523-1431
US

V. Phone/Fax

Practice location:
  • Phone: 217-422-6908
  • Fax: 217-422-7103
Mailing address:
  • Phone: 217-422-6908
  • Fax: 217-422-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180-005694
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22217
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180-005694
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-005694
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number180-005694
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number180-005694
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number180-005694
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number180-005694
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number180-005694
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number180-005694
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: