=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770268955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANE L. STRICK LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2023
-----------------------------------------------------
Last Update Date | 06/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10049 SW 77TH LOOP
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34481-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-276-3171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10049 SW 77TH LOOP
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34481-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-276-3171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | MH8719
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------