Healthcare Provider Details

I. General information

NPI: 1700807971
Provider Name (Legal Business Name): DIANE MUNRO SEYMOUR LSCSW, SAP, CADC1
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 S PINE ST
OTTAWA KS
66067-3242
US

IV. Provider business mailing address

1047 S PINE ST
OTTAWA KS
66067-3242
US

V. Phone/Fax

Practice location:
  • Phone: 785-242-0500
  • Fax: 785-242-7922
Mailing address:
  • Phone: 785-242-0500
  • Fax: 785-242-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number12573
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1893
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKS1893
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: