Provider Demographics
NPI:1750416640
Name:SMITH, DIANNE EASTON (MFT)
Entity type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:EASTON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MISS
Other - First Name:DIANNE
Other - Middle Name:
Other - Last Name:EASTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:217 CEDAR ST
Mailing Address - Street 2:#86
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1410
Mailing Address - Country:US
Mailing Address - Phone:951-440-0982
Mailing Address - Fax:
Practice Address - Street 1:102 S 1ST AVE
Practice Address - Street 2:#202
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1398
Practice Address - Country:US
Practice Address - Phone:951-440-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT16249106H00000X
IDLMFT5489106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist