Provider Demographics
NPI:1831231448
Name:LA MAR, DIANE LOUISE (LPC)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LOUISE
Last Name:LA MAR
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 1:16471 S HAWKINS RD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-9328
Mailing Address - Country:US
Mailing Address - Phone:573-443-4038
Mailing Address - Fax:573-657-1125
Practice Address - Street 1:1005 CHERRY ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7930
Practice Address - Country:US
Practice Address - Phone:573-443-4038
Practice Address - Fax:573-657-1125
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000750101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health