Provider Information for 1225465644
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DIANE LISA NEAL M.S. , lpcc
Sex: Female
NPI: 1225465644
Last Updated: 2022-10-03
Certification Date: 2022-10-03
Certification Date: 2022-10-03
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225465644 | ||||||||||||||||
| Enumeration Date | 2013-09-30 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 29607 139TH ST NW PRINCETON, MN 55371-3688 United States Phone: 763-203-5550 | Fax: | ||||||||||||||||
| Primary Practice Address | 450 JEFFERSON BLVD STE 4 BIG LAKE, MN 55309-1902 United States Phone: 763-631-6325 | Fax: | ||||||||||||||||
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