Provider Demographics
NPI:1700807971
Name:SEYMOUR, DIANE MUNRO (LSCSW, SAP, CADC1)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:MUNRO
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:LSCSW, SAP, CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-3242
Mailing Address - Country:US
Mailing Address - Phone:785-242-0500
Mailing Address - Fax:785-242-7922
Practice Address - Street 1:1047 S PINE ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3242
Practice Address - Country:US
Practice Address - Phone:785-242-0500
Practice Address - Fax:785-242-7922
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12573101YA0400X
KS1893101YM0800X
KSKS18931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical