Provider Demographics
NPI:1164517165
Name:HOSTETTLER, DIANA M (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:HOSTETTLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:BAYLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1064 REDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1075
Mailing Address - Country:US
Mailing Address - Phone:570-297-4352
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-286-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0154191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical