Diane Lisa Neal, M.S. , LPCC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

CC00690 Issued in MN

Practice address

450 Jefferson Blvd Ste 4
Big Lake, MN 55309-1902

Phone

(763) 631-6325

NPI assigned

Sep 30, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifesplace Counseling, Consulting and Coaching

  • Counselor
  • Big Lake, MN
  • NPI 1790409639
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1225465644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29607 139TH ST NW",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553713688",
            "telephone_number": "763-203-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 JEFFERSON BLVD STE 4",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "553091902",
            "telephone_number": "763-631-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEAL",
        "first_name": "DIANE",
        "middle_name": "LISA",
        "credential": "M.S. , LPCC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-30",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "CC00690",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "CC00690",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MN",
            "license": "CC00690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Big Lake, MN
• Providers in Big Lake, MN by specialty
• Professional Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.