Provider Demographics
NPI:1598930885
Name:MOUNT, DIANA JEAN (LMSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:JEAN
Last Name:MOUNT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:JEAN
Other - Last Name:ROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:945 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-1117
Mailing Address - Country:US
Mailing Address - Phone:515-235-8822
Mailing Address - Fax:515-241-0993
Practice Address - Street 1:1301 CENTER ST.
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1004
Practice Address - Country:US
Practice Address - Phone:515-243-5181
Practice Address - Fax:515-243-2760
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0070781041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker