Sandra Dietle, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

2076 Issued in MS

Practice address

8830 Centre St Ste 5
Southaven, MS 38671-2609

Phone

(662) 253-8324

Fax

(662) 253-8336

NPI assigned

Sep 1, 2011

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 17, 2018.

{
    "created_epoch": "1314835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1992086151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8830 CENTRE ST STE 5",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712609",
            "telephone_number": "662-253-8324",
            "fax_number": "662-253-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8830 CENTRE ST STE 5",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386712609",
            "telephone_number": "662-253-8324",
            "fax_number": "662-253-8336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4253 N Crossover Rd",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727034593",
            "country_code": "US",
            "telephone_number": "479-521-5731",
            "fax_number": "479-443-2519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIETLE",
        "first_name": "SANDRA",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-01",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MS",
            "license": "2076",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "MS",
            "license": "2076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyrel Detweiler, D.C.
• Mahfuz Mahin Dewan
• Jennifer Dewey, FNP
• DHP of Desoto Professional Association
• Diabetes Store, Incorporated
• Jena Dimberg, MS CCC SLP
• Challandore Disorbo
• Diversicare of Southaven, LLC
• DLC Home Care Solutions
• Cori Dodson

• All providers in Southaven, MS
• Professional Counselor in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.