Provider Demographics
NPI:1679800817
Name:SMALING, DIANE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LYNN
Last Name:SMALING
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 1:3614 W 109TH ST S
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-1811
Mailing Address - Country:US
Mailing Address - Phone:918-856-6604
Mailing Address - Fax:
Practice Address - Street 1:3614 W 109TH ST S
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-1811
Practice Address - Country:US
Practice Address - Phone:918-209-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK49931041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical