Healthcare Provider Details

I. General information

NPI: 1275736282
Provider Name (Legal Business Name): DIANA RAE BULLER TORRES LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MAIN ST
HALSTEAD KS
67056-1708
US

IV. Provider business mailing address

720 MEDICAL CENTER DR
NEWTON KS
67114-8778
US

V. Phone/Fax

Practice location:
  • Phone: 316-835-3700
  • Fax: 316-283-1333
Mailing address:
  • Phone: 316-283-6103
  • Fax: 316-283-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2348
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: