Provider Demographics
NPI:1912921560
Name:MARTI, DIANE C (PHD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:MARTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNION DR.
Mailing Address - Street 2:STE 206
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6652
Mailing Address - Country:US
Mailing Address - Phone:402-489-2218
Mailing Address - Fax:402-489-3666
Practice Address - Street 1:3801 UNION DR.
Practice Address - Street 2:STE 206
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6652
Practice Address - Country:US
Practice Address - Phone:402-489-2218
Practice Address - Fax:402-489-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2270101YM0800X
NE766103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1799Medicare UPIN