Individual
DIANA LYNN LIVELY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
109 W 2ND ST, TAHLEQUAH, OK 74464-4723
(918) 431-0418
Mailing address
14966 W GRANDVIEW RD, TAHLEQUAH, OK 74464-1120
(918) 931-1971
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
02/04/2013
Last updated
02/04/2013
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