MEDICARE: DIANE PROSPER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	MH20483	FL

General Provider Information

NPI Number	:	1124762422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE PROSPER

Provider Business Mailing Address
First Line	:	8217 OLD GROVE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5687
Country	:	US
Telephone Number	:	407-576-6437
Fax Number	:

Provider Business Practice Location Address
First Line	:	8217 OLD GROVE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-5687
Country	:	US
Telephone Number	:	407-576-6437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2022
Last Update Date	:	04/22/2022

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Directions to “ DIANE PROSPER ” Practice Location

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