Provider Demographics
NPI:1932306610
Name:BOOZE, DIANNA GAIL
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:GAIL
Last Name:BOOZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 S IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-4037
Mailing Address - Country:US
Mailing Address - Phone:405-258-9951
Mailing Address - Fax:
Practice Address - Street 1:112 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-2820
Practice Address - Country:US
Practice Address - Phone:405-258-2178
Practice Address - Fax:405-258-2478
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor