Provider Demographics
NPI:1932484763
Name:LENGKEEK, DIANA BLANCHE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:BLANCHE
Last Name:LENGKEEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-3006
Mailing Address - Country:US
Mailing Address - Phone:307-359-3754
Mailing Address - Fax:
Practice Address - Street 1:917 GILCHRIST STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201
Practice Address - Country:US
Practice Address - Phone:307-359-3754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-612101Y00000X
WYLPC-1330101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106402908Medicaid
WY106402907Medicaid