Basic Information
| Provider Information | |||||||||
| NPI: | 1669561080 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PLEASANT | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PSYD, LCPC, CADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 335 E WOOD ST STE B | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625231431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174226908 | ||||||||
| FaxNumber: | 2174227103 | ||||||||
| Practice Location | |||||||||
| Address1: | 335 E WOOD ST STE B | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174226908 | ||||||||
| FaxNumber: | 2174227103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 180-005694 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Counseling | 101Y00000X | 180-005694 | IL | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 22217 | IL | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 180-005694 | IL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103T00000X | 180-005694 | IL | N | Behavioral Health & Social Service Providers | Psychologist | 103TA0400X | 180-005694 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TB0200X | 180-005694 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TF0000X | 180-005694 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Family | 171M00000X | 180-005694 | IL | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | 180-005694 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 202415440001 | 05 | IL | MEDICAID |