Provider Demographics
NPI:1306400304
Name:WHITNEY, DIANA LYNNE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LYNNE
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LYNNE
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:375 LANE 7 1/2
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-9022
Mailing Address - Country:US
Mailing Address - Phone:307-884-8872
Mailing Address - Fax:
Practice Address - Street 1:375 LANE 7 1/2
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-9022
Practice Address - Country:US
Practice Address - Phone:307-884-8872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY500369-772OtherDRIVERS LICENSE