Individual
MS. DIANA M BASTIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LP
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4294
(417) 761-5000
(417) 761-5065
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4294
(417) 761-5000
(417) 761-5065
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2018030620
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490058980
—
MO
Enumeration date
08/08/2018
Last updated
10/04/2021
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