=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316016702
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE COLETTE BROUGHTON LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 W PEARL ST
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47006-1253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-933-1820
-----------------------------------------------------
Fax | 812-932-1820
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 W PEARL ST
-----------------------------------------------------
City | BATESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47006-1253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-933-1820
-----------------------------------------------------
Fax | 812-932-1820
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 39000014
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------