Provider Demographics
NPI:1568405165
Name:ADAMS, DIANA KAY (MS LCSW)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:KAY
Last Name:ADAMS
Suffix:
Gender:F
Credentials:MS LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S 36TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2952
Mailing Address - Country:US
Mailing Address - Phone:816-232-0077
Mailing Address - Fax:816-232-0077
Practice Address - Street 1:501 S 36TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2952
Practice Address - Country:US
Practice Address - Phone:816-232-0077
Practice Address - Fax:816-232-0077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO17041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7056200Medicare UPIN
MO10001185501Medicare UPIN
MO20965011Medicare UPIN
MO29017Medicare UPIN