Provider Demographics
NPI:1659585305
Name:NYE, DIANA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:NYE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 POWELL HWY
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-8309
Mailing Address - Country:US
Mailing Address - Phone:307-587-9600
Mailing Address - Fax:
Practice Address - Street 1:4733 POWELL HWY
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-8309
Practice Address - Country:US
Practice Address - Phone:307-587-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical