Healthcare Provider Details

I. General information

NPI: 1740366285
Provider Name (Legal Business Name): DIANNE JOYCE PSYD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12277 DEPAUL DR SUITE 200
ST LOUIS MO
63044-2529
US

IV. Provider business mailing address

12417 CABOT MANOR CIRCLE
ST LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6844
  • Fax: 314-344-6801
Mailing address:
  • Phone: 314-369-8845
  • Fax: 314-344-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberCS002336
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: