Provider Demographics
NPI:1437448412
Name:EARHART, DIANA LEIGH (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LEIGH
Last Name:EARHART
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19402 GUM RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-8144
Mailing Address - Country:US
Mailing Address - Phone:417-673-7688
Mailing Address - Fax:
Practice Address - Street 1:2810 MOUNT HOPE RD
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-9674
Practice Address - Country:US
Practice Address - Phone:417-624-9659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110033671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical