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General NPI Number Information
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NPI Number | 1114542669
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Entity Type | Organization
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Legal Business Name | DIANE LIN PHD LLC
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 06/10/2020
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Provider Practice Location Address
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Address Line | 1627 W COLONIAL PKWY STE 302
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City | INVERNESS
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State | IL
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Zip | 60067-4732
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Country | US
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Telephone | 224-662-0015
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Fax |
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Provider Business Mailing Address
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Address Line | 879 N HAMILTON CT
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City | PALATINE
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State | IL
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Zip | 60067-3483
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Country | US
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Telephone | 224-662-0015
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. DIANE L LIN
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Credential | PHD
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Telephone | 224-662-0015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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