Provider Demographics
NPI:1295709244
Name:MUELLER, DIANA M (LPC-MH)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:M
Last Name:MUELLER
Suffix:
Gender:F
Credentials:LPC-MH
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:SOUTHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-MH
Mailing Address - Street 1:12307 VALHALLA DR
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-5517
Mailing Address - Country:US
Mailing Address - Phone:605-646-0223
Mailing Address - Fax:
Practice Address - Street 1:2404 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3450
Practice Address - Country:US
Practice Address - Phone:605-737-0769
Practice Address - Fax:605-721-1196
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH30555101YP2500X
SD1985104100000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker