Braley Nichole Dietzen, MS, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

106 Edwards St
Newton, IL 62448-1736

Phone

(618) 783-4154

NPI assigned

Apr 20, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618876800000",
    "number": "1386225415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 EDWARDS ST",
            "city": "NEWTON",
            "state": "IL",
            "postal_code": "624481736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 EDWARDS ST",
            "city": "NEWTON",
            "state": "IL",
            "postal_code": "624481736",
            "telephone_number": "618-783-4154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZEN",
        "first_name": "BRALEY",
        "middle_name": "NICHOLE",
        "name_prefix": "Miss",
        "credential": "MS, LPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-20",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• County of Jasper
• Crawford Hospital District
• Amy Deel-Hout, MS, LCPC
• Donna Dhom, RN
• Roxann Cozette Dhom, PMHNP
• Debra Doan
• Lenora Drees, F.N.P.
• Jennifer Eaton, MS
• Mary Jo Emmerich
• Jeanine Marie Fell, DDS

• Mental Health Counselor in Newton, IL
• Providers in Newton, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; 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.