Provider Demographics
NPI:1265680334
Name:WASSER, DIANA G (LPC)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:G
Last Name:WASSER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 MAIN ST STE 214
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5757
Mailing Address - Country:US
Mailing Address - Phone:208-949-1374
Mailing Address - Fax:208-392-1259
Practice Address - Street 1:910 MAIN ST STE 214
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5757
Practice Address - Country:US
Practice Address - Phone:208-949-1374
Practice Address - Fax:208-392-1259
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health