Active NPI
Diane Clodi, LPC
- Professional Counselor
- Mesa, AZ
National Provider Identifier
1063529147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5439T
- Practice address
- 4240 Florian Avenue
Building 1
Mesa, AZ 85206 - Phone
- (480) 844-1653
- NPI assigned
- Aug 24, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 108005379 | IL | |
| Professional Counselor | 101YP2500X | 5439T | AZ | Primary |
Addresses
Primary practice location
4240 Florian Avenue
Building 1
Mesa, AZ 85206
Mailing address
4240 Florian Ave.
Mesa, AZ 85206
Phone (480) 844-1653
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1634997 | Other | IL | BCBS NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5439T | AZ | MD | Professional Counselor |
| 108005379 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370908800000",
"number": "1063529147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4240 FLORIAN AVE.",
"city": "MESA",
"state": "AZ",
"postal_code": "85206",
"telephone_number": "480-844-1653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4240 FLORIAN AVENUE",
"address_2": "BUILDING 1",
"city": "MESA",
"state": "AZ",
"postal_code": "85206",
"telephone_number": "480-844-1653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLODI",
"first_name": "DIANE",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-24",
"last_updated": "2013-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "108005379",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AZ",
"license": "5439T",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS NUMBER",
"identifier": "1634997",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.