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Individual

DR. DIANE M BRANDMILLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
2592 N. GREGG AVENUE, SUITE 34, FAYETTEVILLE, AR 72703
(479) 225-7799
Mailing address
PO BOX 1510, WEST PLAINS, MO 65775

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
05-14P
AR
103TC0700X
Clinical Psychologist
Primary
2013010695
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
162149719
DOMHA MCD
AR
01
5A091
DOMHA BCBS
AR
01
5Y827
DOMHA MCR
AR
01
P00363
DOMHA MCR RR
AR
Enumeration date
06/18/2006
Last updated
05/28/2013
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