Provider Demographics
NPI:1275736282
Name:BULLER TORRES, DIANA RAE (LSCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:RAE
Last Name:BULLER TORRES
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-8778
Mailing Address - Country:US
Mailing Address - Phone:316-283-6103
Mailing Address - Fax:316-283-1333
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:HALSTEAD
Practice Address - State:KS
Practice Address - Zip Code:67056-1708
Practice Address - Country:US
Practice Address - Phone:316-835-3700
Practice Address - Fax:316-283-1333
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200442150AMedicaid