Healthcare Provider Details

I. General information

NPI: 1295709244
Provider Name (Legal Business Name): DIANA M MUELLER LPC-MH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANA M SOUTHAM LPC-MH

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 QUINCY ST STE 102B
RAPID CITY SD
57701-8230
US

IV. Provider business mailing address

623 QUINCY ST STE 102B
RAPID CITY SD
57701-8230
US

V. Phone/Fax

Practice location:
  • Phone: 605-646-0223
  • Fax:
Mailing address:
  • Phone: 605-646-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-MH30555
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1985
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: