MEDICARE: MS. DIANA ELIZABETH LINGREN MA LMHP LPC RPTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	1650	WY
2	101YM0800X	Mental Health Counselor	189	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84067	OTHER	NE	BCBS

General Provider Information

NPI Number	:	1922147057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DIANA ELIZABETH LINGREN MA LMHP LPC RPTS

Provider Business Mailing Address
First Line	:	1430 WILKINS CIR
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1336
Country	:	US
Telephone Number	:	307-237-9583
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 WILKINS CIR
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1336
Country	:	US
Telephone Number	:	307-237-9583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	06/16/2017

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