Individual
DIANA KAY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.I.M.H.P.
Contact information
Practice address
518 S JEFFERS ST STE 7, NORTH PLATTE, NE 69101-5370
(308) 221-2141
(308) 221-2141
Mailing address
518 S JEFFERS ST STE 7, NORTH PLATTE, NE 69101-5370
(308) 221-2141
(308) 221-2141
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
700
NE
101YM0800X
Mental Health Counselor
Primary
583
NE
106H00000X
Marriage & Family Therapist
265
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025816000
—
NE
01
—
82473
BLUE CROSS BLUE SHIELD OF NEBRASKA
NE
Enumeration date
10/20/2006
Last updated
02/11/2010
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