Healthcare Provider Details

I. General information

NPI: 1437448412
Provider Name (Legal Business Name): DIANA LEIGH EARHART MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 MOUNT HOPE RD
WEBB CITY MO
64870-9674
US

IV. Provider business mailing address

19402 GUM RD
JOPLIN MO
64801-8144
US

V. Phone/Fax

Practice location:
  • Phone: 417-624-9659
  • Fax:
Mailing address:
  • Phone: 417-673-7688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011003367
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: