Doctor Name: | DIANA KAY WALLACE |
NPI Number: | 1457433146 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.I.M.H.P. |
License Number: | 700 |
Business Practice Address: | 518 S Jeffers St Ste 7 North Platte, NE - 691015370 |
Business Phone Number: | 3082212141 |
Business Fax Number: | 3082212141 |
Mailing Address: | 518 S Jeffers St Ste 7, NORTH PLATTE |
State: | NE |
Postal Code: | 691015370 |
Phone Number: | 3082212141 |
Fax Number: | 3082212141 |
NPI Enumeration Date: | 10/20/2006 |
NPI Last Update Date: | 02/11/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 700 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NE |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |