Individual
DIANE KAY RELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LMFT, LADC
Contact information
Practice address
1406 6TH AVE N, ST CLOUD HOSPITAL, SAINT CLOUD, MN 56303-1900
(320) 251-2700
(320) 656-7715
Mailing address
1406 6TH AVE N, ST CLOUD HOSPITAL, SAINT CLOUD, MN 56303-1900
(320) 251-2700
(320) 656-7715
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
300163
MN
101YA0400X
Addiction (Substance Use Disorder) Counselor
300163
MN
106H00000X
Marriage & Family Therapist
Primary
2067
MN
Other
Enumeration date
11/15/2010
Last updated
04/01/2015
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