1306400304 NPI number — MS. DIANA LYNNE WHITNEY MS, LPC

Table of content: (NPI 1730767542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306400304 NPI number — MS. DIANA LYNNE WHITNEY MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITNEY
Provider First Name:
DIANA
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WHITNEY
Provider Other First Name:
DIANA
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306400304
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
375 LANE 7 1/2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82435-9022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-884-8872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
375 LANE 7 1/2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82435-9022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-884-8872
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  644 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500369-772 . This is a "DRIVERS LICENSE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".