Provider Demographics
NPI:1023365392
Name:DIAMOND, JOAN (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5593
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-5593
Mailing Address - Country:US
Mailing Address - Phone:406-295-5400
Mailing Address - Fax:406-295-5420
Practice Address - Street 1:31733 S FORK YAAK RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MT
Practice Address - Zip Code:59935-8681
Practice Address - Country:US
Practice Address - Phone:406-295-5401
Practice Address - Fax:406-295-5420
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2308101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2308OtherSTATE