Individual
DIANE WATSON MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4460 CENTRAL WAY, SUITE 2, CHUBBUCK, ID 83202-5095
(208) 237-1711
(208) 237-5192
Mailing address
4460 CENTRAL WAY, SUITE 2, CHUBBUCK, ID 83202-5095
(208) 237-1711
(208) 237-5192
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCSW726
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807197600
—
ID
Enumeration date
12/18/2008
Last updated
12/18/2008
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