Healthcare Provider Details

I. General information

NPI: 1265680334
Provider Name (Legal Business Name): DIANA G. WASSER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 W ST LUKES DR
NAMPA ID
83687-7912
US

IV. Provider business mailing address

1762 N TODD WAY
MERIDIAN ID
83646-1205
US

V. Phone/Fax

Practice location:
  • Phone: 208-505-2222
  • Fax: 208-453-4255
Mailing address:
  • Phone: 208-949-1374
  • Fax: 208-392-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-6023
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: