Wallace, Diana Kay

Wallace, Diana Kay is an individual health care provider with primary practice located at 518 S Jeffers St Ste 7 , North Platte NE 69101-5370. She recently has 3 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Marriage & Family Therapist. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Wallace, Diana Kay can be contacted via phone (308) 221-2141.

Contact Information

Primary practice address
518 S Jeffers St Ste 7 North Platte NE 69101-5370
Phone: (308) 221-2141
Fax: (308) 221-2141
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 700 Nebraska
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 583 Nebraska
Behavioral Health & Social Service Providers / Marriage & Family Therapist 106H00000X 265 Nebraska

Profile Details

NPI number 1457433146
LBN Legal business name Wallace, Diana Kay
Credentials L.I.M.H.P.
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 20th, 2006
Last updated Feb 11th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457433146 NPPES
Nebraska Other 82473 BLUE CROSS BLUE SHIELD OF NEBRASKA
Nebraska MEDICAID 10025816000 BLUE CROSS BLUE SHIELD OF NEBRASKA

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