Healthcare Provider Details

I. General information

NPI: 1548378771
Provider Name (Legal Business Name): DIANNE KAY KRUSE LCPC MA, EED, EDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANNE KAY HICKEY LCPC

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 06/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 12TH AVE S
NAMPA ID
83651
US

IV. Provider business mailing address

1214 12TH AVE S
NAMPA ID
83651
US

V. Phone/Fax

Practice location:
  • Phone: 208-466-2666
  • Fax: 208-467-4598
Mailing address:
  • Phone: 208-466-2666
  • Fax: 208-467-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number148
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number148
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: