Healthcare Provider Details

I. General information

NPI: 1922147057
Provider Name (Legal Business Name): DIANA ELIZABETH LINGREN MA LMHP LPC RPTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 06/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 WILKINS CIR
CASPER WY
82601-1336
US

IV. Provider business mailing address

1430 WILKINS CIR
CASPER WY
82601-1336
US

V. Phone/Fax

Practice location:
  • Phone: 307-237-9583
  • Fax:
Mailing address:
  • Phone: 307-237-9583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number189
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1650
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: