Healthcare Provider Details

I. General information

NPI: 1477579340
Provider Name (Legal Business Name): DIANE PERRY-ADLER LIC PSYCHOLOGICAL PR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E FRAZIER AVE
COLUMBIA KY
42728-1915
US

IV. Provider business mailing address

130 SOUTHERN SCHOOL RD
SOMERSET KY
42501-3223
US

V. Phone/Fax

Practice location:
  • Phone: 270-384-4710
  • Fax: 270-384-4820
Mailing address:
  • Phone: 606-679-4782
  • Fax: 606-678-5296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number114174
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: