Provider Demographics
NPI:1083745400
Name:ANDERSON, DIANE LYN (BS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 B TERRACE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052
Mailing Address - Country:US
Mailing Address - Phone:719-336-3203
Mailing Address - Fax:
Practice Address - Street 1:3500 FIRST STREET SOUTH
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052
Practice Address - Country:US
Practice Address - Phone:719-336-7501
Practice Address - Fax:719-336-7453
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor