Provider Demographics
NPI:1710284203
Name:ANDERSON, DIANE MARIE (LMHP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 N 144TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4715
Mailing Address - Country:US
Mailing Address - Phone:402-960-8130
Mailing Address - Fax:
Practice Address - Street 1:1710 N 144TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4715
Practice Address - Country:US
Practice Address - Phone:402-960-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health